Provider Demographics
NPI:1245259001
Name:CRIDER, LEE (LICSW)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:CRIDER
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:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-479-2502
Mailing Address - Fax:
Practice Address - Street 1:50 GRANVIEW DR
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5113
Practice Address - Country:US
Practice Address - Phone:802-479-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00004821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00029836OtherBC/BS OF VERMONT
VT1007325Medicaid
VT360274OtherTRICARE
VT989026COtherMVP HEALTHCARE
VT2078940OtherCIGNA
VT360274OtherTRICARE