Healthcare Provider Details

I. General information

NPI: 1053467233
Provider Name (Legal Business Name): ARLENE SORGEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARLENE O'SULLIVAN

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 PINE ST
BURLINGTON VT
05401-5353
US

IV. Provider business mailing address

1138 PINE ST
BURLINGTON VT
05401-5353
US

V. Phone/Fax

Practice location:
  • Phone: 802-863-1326
  • Fax:
Mailing address:
  • Phone: 802-863-1326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000441
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: