Provider Demographics
NPI:1124855671
Name:MUMFORD, ANNA (LICSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MUMFORD
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:PO BOX 4009
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05406-4009
Mailing Address - Country:US
Mailing Address - Phone:802-557-1939
Mailing Address - Fax:802-488-3711
Practice Address - Street 1:50 JOY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6118
Practice Address - Country:US
Practice Address - Phone:802-557-1939
Practice Address - Fax:802-861-6460
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01325061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical