Provider Demographics
NPI:1154162816
Name:HEARST, MICHAELA EMILY (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:EMILY
Last Name:HEARST
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 1:23 YORKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6189
Mailing Address - Country:US
Mailing Address - Phone:917-715-5335
Mailing Address - Fax:
Practice Address - Street 1:23 YORKSHIRE CIR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6189
Practice Address - Country:US
Practice Address - Phone:917-715-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01358901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical