Provider Demographics
NPI:1962551598
Name:LOTSPEICH, JUDITH T (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:T
Last Name:LOTSPEICH
Suffix:
Gender:F
Credentials:LCSW
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 156
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-0156
Mailing Address - Country:US
Mailing Address - Phone:802-244-6178
Mailing Address - Fax:
Practice Address - Street 1:1080 WATERBURY STOWE RD
Practice Address - Street 2:STE 3 THE COLBY MANSION
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-8931
Practice Address - Country:US
Practice Address - Phone:802-244-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00007211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008152Medicaid
VT58393OtherBCBS OF VT