Healthcare Provider Details

I. General information

NPI: 1821843533
Provider Name (Legal Business Name): LISA HALKIAS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 SOUTH ST APT A6
BENNINGTON VT
05201-2381
US

IV. Provider business mailing address

432 SOUTH ST APT A6
BENNINGTON VT
05201-2381
US

V. Phone/Fax

Practice location:
  • Phone: 802-375-5089
  • Fax:
Mailing address:
  • Phone: 802-375-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0137353
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: