Healthcare Provider Details

I. General information

NPI: 1760411987
Provider Name (Legal Business Name): THOMAS A PAQUETTE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLYNN AVE
BURLINGTON VT
05401-5301
US

IV. Provider business mailing address

119 HARDY AVE
BURLINGTON VT
05401-1203
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-0400
  • Fax:
Mailing address:
  • Phone: 802-864-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000540
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: