Provider Demographics
NPI:1386931830
Name:PROVETTO, SALVATORE JOSEPH (LICSW)
Entity type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:JOSEPH
Last Name:PROVETTO
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 1:354 MOUNTAIN VIEW DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5923
Mailing Address - Country:US
Mailing Address - Phone:802-661-4376
Mailing Address - Fax:802-655-1130
Practice Address - Street 1:354 MOUNTAIN VIEW DR STE 105
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5923
Practice Address - Country:US
Practice Address - Phone:802-377-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900713131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical