Provider Demographics
NPI:1124233994
Name:LAWLOR, COLEEN (LICSW)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:LAWLOR
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 1:211 DARBY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-3113
Mailing Address - Country:US
Mailing Address - Phone:802-463-9746
Mailing Address - Fax:
Practice Address - Street 1:211 DARBY HILL RD
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101-3113
Practice Address - Country:US
Practice Address - Phone:802-463-9746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0890011291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical