Provider Demographics
NPI:1710434717
Name:MEGAN POOR LICSW
Entity Type:Organization
Organization Name:MEGAN POOR LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POOR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-598-4412
Mailing Address - Street 1:54 W TWIN OAKS TER
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7140
Mailing Address - Country:US
Mailing Address - Phone:802-598-4412
Mailing Address - Fax:
Practice Address - Street 1:54 W TWIN OAKS TER
Practice Address - Street 2:SUITE 12
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7140
Practice Address - Country:US
Practice Address - Phone:802-598-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00456941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty