Healthcare Provider Details

I. General information

NPI: 1780598102
Provider Name (Legal Business Name): MAVERICK JOYCE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAPLE ST STE 320
BURLINGTON VT
05401-4956
US

IV. Provider business mailing address

47 MAPLE ST STE 320
BURLINGTON VT
05401-4956
US

V. Phone/Fax

Practice location:
  • Phone: 518-338-5115
  • Fax:
Mailing address:
  • Phone: 518-338-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0135825
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: