Provider Demographics
NPI:1982796496
Name:MCCLINTOCK, MAUREEN MATTHEWS (MSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MATTHEWS
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 ROLLIN RD.
Mailing Address - Street 2:
Mailing Address - City:N. BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:01527
Mailing Address - Country:US
Mailing Address - Phone:802-442-4426
Mailing Address - Fax:
Practice Address - Street 1:655 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-447-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00000901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2179Medicaid
VT18287OtherBC/BS
VT2025496OtherCIGNA
VT350642OtherMVP
VT350642OtherMVP