Provider Demographics
NPI:1528339959
Name:BOSTON, DEBORAH E (LICSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:E
Last Name:BOSTON
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 1:2568 LINCOLN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05738-9645
Mailing Address - Country:US
Mailing Address - Phone:802-681-8548
Mailing Address - Fax:
Practice Address - Street 1:128 MERCHANTS ROW STE 510
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-855-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00794501041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020156Medicaid
NY03967782Medicaid
VTY400162775Medicare PIN