Provider Demographics
NPI:1487126553
Name:BEIDLER, MEGAN MARIE TROXELL (LICSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE TROXELL
Last Name:BEIDLER
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: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:903-258-7805
Mailing Address - Fax:
Practice Address - Street 1:2458 CHRISTIAN ST STE 214
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9888
Practice Address - Country:US
Practice Address - Phone:903-258-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01341561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1036038Medicaid
NH3118761Medicaid