Provider Demographics
NPI:1124086582
Name:WARD, JOHN (LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WARD
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 1:79 WEAVER STREET
Mailing Address - Street 2:PO BOX 127 VERMONT CHILDRENS AID SOCIETY
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-0127
Mailing Address - Country:US
Mailing Address - Phone:802-655-0006
Mailing Address - Fax:802-655-0073
Practice Address - Street 1:79 WEAVER STREET
Practice Address - Street 2:VERMONT CHILDRENS AID SOCIETY
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-0127
Practice Address - Country:US
Practice Address - Phone:802-655-0006
Practice Address - Fax:802-655-0073
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900006751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT38771OtherBLUE CROSS BLUE SHIELD
VT1006817Medicaid
VT383035OtherMVP HEALTH CARE