Healthcare Provider Details

I. General information

NPI: 1912820820
Provider Name (Legal Business Name): RENICK WELLS LALANCETTE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LAKESIDE AVE STE 260
BURLINGTON VT
05401-5911
US

IV. Provider business mailing address

128 LAKESIDE AVE STE 260
BURLINGTON VT
05401-5911
US

V. Phone/Fax

Practice location:
  • Phone: 802-657-7045
  • Fax:
Mailing address:
  • Phone: 802-657-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0137238
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: