Provider Demographics
NPI:1942302476
Name:JEROME, JUDITH L (MSW, LICSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:L
Last Name:JEROME
Suffix:
Gender:F
Credentials:MSW, LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-9796
Mailing Address - Country:US
Mailing Address - Phone:802-651-7503
Mailing Address - Fax:
Practice Address - Street 1:15 PINECREST DR
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2912
Practice Address - Country:US
Practice Address - Phone:802-651-7503
Practice Address - Fax:802-878-4404
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00004171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT16412OtherUNITED BEHAVIORAL HEALTH
VT03036OtherCBA
VT19498OtherBCBS VT
VT29123OtherCIGNA
VT368093OtherMVP
VT1007929Medicaid
VT19498OtherBCBS VT