Provider Demographics
NPI:1841204708
Name:RABINOVITZ, LAURA ANNE (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:RABINOVITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S PROSPECT ST
Mailing Address - Street 2:ST JOESPH'S 6TH FLOOR
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3456
Mailing Address - Country:US
Mailing Address - Phone:802-847-1415
Mailing Address - Fax:
Practice Address - Street 1:28 HOWARD ST
Practice Address - Street 2:STE 205
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-0540
Practice Address - Country:US
Practice Address - Phone:802-238-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00005861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008131Medicaid
VN 1499Medicare ID - Type Unspecified