Provider Demographics
NPI:1285077719
Name:NANCY B BIRGE, LICSW, PLC
Entity type:Organization
Organization Name:NANCY B BIRGE, LICSW, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BIRGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:802-291-3907
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:VT
Mailing Address - Zip Code:05088-0842
Mailing Address - Country:US
Mailing Address - Phone:802-356-9393
Mailing Address - Fax:
Practice Address - Street 1:2458 CHRISTIAN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9855
Practice Address - Country:US
Practice Address - Phone:802-356-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900012531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty