Provider Demographics
NPI:1720664196
Name:KIRSCHENBAUM, LILY
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:KIRSCHENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BOBBINSHOP RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:VT
Mailing Address - Zip Code:05038-8926
Mailing Address - Country:US
Mailing Address - Phone:802-477-2211
Mailing Address - Fax:
Practice Address - Street 1:15 E STATE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3086
Practice Address - Country:US
Practice Address - Phone:802-505-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134965104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker