Provider Demographics
NPI:1699795617
Name:EDWARDS-ORR, JAMIE ANNE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ANNE
Last Name:EDWARDS-ORR
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 1:145 PINE HAVEN SHORES RD
Mailing Address - Street 2:SUITE 2061
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7703
Mailing Address - Country:US
Mailing Address - Phone:802-985-5778
Mailing Address - Fax:802-985-5779
Practice Address - Street 1:145 PINE HAVEN SHORES RD
Practice Address - Street 2:SUITE 2061
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-985-5778
Practice Address - Fax:802-985-5779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00001111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009866Medicaid
VT0009866Medicaid