Provider Demographics
NPI:1750883856
Name:BISS, CHARLES A (LICSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:BISS
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 1:74 MUNSILL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1047
Mailing Address - Country:US
Mailing Address - Phone:802-453-5028
Mailing Address - Fax:
Practice Address - Street 1:74 MUNSILL AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1047
Practice Address - Country:US
Practice Address - Phone:802-453-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00001071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical