Healthcare Provider Details

I. General information

NPI: 1356646996
Provider Name (Legal Business Name): SUSAN WILLIAMS WRIGHT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LEDGEHILL RD
BENNINGTON VT
05201-2273
US

IV. Provider business mailing address

100 LEDGEHILL RD
BENNINGTON VT
05201-2273
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0119321
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16640
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: