Healthcare Provider Details

I. General information

NPI: 1700304417
Provider Name (Legal Business Name): VANESSA BLAIS O'SHEA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA CHANNELL BLAIS MSW,LMSW

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E SHORE N
GRAND ISLE VT
05458-2348
US

IV. Provider business mailing address

PO BOX 512
SOUTH HERO VT
05486-0512
US

V. Phone/Fax

Practice location:
  • Phone: 802-234-1109
  • Fax: 802-419-9557
Mailing address:
  • Phone: 802-234-1109
  • Fax: 802-419-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0134488
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: