Provider Demographics
NPI:1811387962
Name:BEHRSING, ELIZA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:
Last Name:BEHRSING
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 1:80 FLETCHER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-9537
Mailing Address - Country:US
Mailing Address - Phone:802-497-4913
Mailing Address - Fax:
Practice Address - Street 1:5399 WILLISTON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-5320
Practice Address - Country:US
Practice Address - Phone:802-489-5826
Practice Address - Fax:802-495-5940
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00859111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1024531Medicaid