Provider Demographics
NPI:1134209414
Name:NORFORD, DOUGLAS W (LICSW)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:NORFORD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SUGAR HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05763-9883
Mailing Address - Country:US
Mailing Address - Phone:802-483-6645
Mailing Address - Fax:
Practice Address - Street 1:78 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4530
Practice Address - Country:US
Practice Address - Phone:802-775-8224
Practice Address - Fax:802-747-7699
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900005311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1900Medicaid
VT00029287OtherBCBS
VTVN1900Medicare ID - Type Unspecified