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NPI Code Detail

MEDICARE: MARGOT C PRENDERGAST LICSW

MEDICARE: MARGOT C PRENDERGAST LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker089-0001275VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164663035
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARGOT C PRENDERGAST LICSW
Provider Business Mailing Address
First Line : 24 STORY RD
Second Line :
City : NORTH MIDDLESEX
State : VT
Zip : 05682-9662
Country : US
Telephone Number : 802-272-6559
Fax Number :
Provider Business Practice Location Address
First Line : 65 NORTHGATE PLAZA
Second Line : SUITE 11
City : MORRISVILLE
State : VT
Zip : 05661-5900
Country : US
Telephone Number : 802-888-8320
Fax Number : 802-888-8136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2009
Last Update Date : 06/01/2012

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Directions to “ MARGOT C PRENDERGAST LICSW” Practice Location

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