Healthcare Provider Details

I. General information

NPI: 1346585247
Provider Name (Legal Business Name): LAURA G ETHIER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GROVE ST
BRANDON VT
05733-9062
US

IV. Provider business mailing address

215 STRATTON RD
RUTLAND VT
05701-4621
US

V. Phone/Fax

Practice location:
  • Phone: 802-247-6305
  • Fax: 802-247-6040
Mailing address:
  • Phone: 802-855-2027
  • Fax: 802-855-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0001266
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: