Provider Demographics
NPI:1699854083
Name:BATE, LEILA WILSON (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LEILA
Middle Name:WILSON
Last Name:BATE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WRIGHT ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:VT
Mailing Address - Zip Code:05146-9769
Mailing Address - Country:US
Mailing Address - Phone:802-843-1175
Mailing Address - Fax:
Practice Address - Street 1:777 WRIGHT ORCHARD RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VT
Practice Address - Zip Code:05146-9769
Practice Address - Country:US
Practice Address - Phone:802-843-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00009771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011808Medicaid