Provider Demographics
NPI:1750603650
Name:POOR, MEGAN (LICSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:POOR
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 1:24 OBRIEN DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6322
Mailing Address - Country:US
Mailing Address - Phone:802-598-6545
Mailing Address - Fax:
Practice Address - Street 1:1795 WILLISTON RD STE 330
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6487
Practice Address - Country:US
Practice Address - Phone:802-598-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900456941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical