Provider Demographics
NPI:1346585247
Name:ETHIER, LAURA G (LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:ETHIER
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 1:215 STRATTON RD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4621
Mailing Address - Country:US
Mailing Address - Phone:802-855-2027
Mailing Address - Fax:802-855-2053
Practice Address - Street 1:420 GROVE ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-9062
Practice Address - Country:US
Practice Address - Phone:802-247-6305
Practice Address - Fax:802-247-6040
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0001266104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021427Medicaid