Provider Demographics
NPI:1154387496
Name:REED, PAUL J (LICSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:REED
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 1:153 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3361
Mailing Address - Country:US
Mailing Address - Phone:802-229-6229
Mailing Address - Fax:
Practice Address - Street 1:153 STATE STREET
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3361
Practice Address - Country:US
Practice Address - Phone:802-229-6229
Practice Address - Fax:802-223-1338
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00001321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009926Medicaid
VT0009926Medicaid