Healthcare Provider Details

I. General information

NPI: 1659389443
Provider Name (Legal Business Name): NANCY BANFIELD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEDGEHILL RD
BENNINGTON VT
05201-2273
US

IV. Provider business mailing address

PO BOX 588
BENNINGTON VT
05201-0588
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-5491
  • Fax: 802-442-4910
Mailing address:
  • Phone: 802-442-5491
  • Fax: 802-442-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number089-0000494
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number089-0000494
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number089-0000494
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089-0000494
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000494
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: