Provider Demographics
NPI:1962412684
Name:REID, CHRISTINE R (MSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:R
Last Name:REID
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:LUSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:390 RIVER STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156
Practice Address - Country:US
Practice Address - Phone:802-886-4500
Practice Address - Fax:802-886-4560
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010192201041C0700X
VT089.00846491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO491053906Medicaid