Healthcare Provider Details

I. General information

NPI: 1083808992
Provider Name (Legal Business Name): GRETCHEN HOLLY BAUMGARDNER X L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 COLLEGE ST #1
MONTPELIER VT
05602-3115
US

IV. Provider business mailing address

45 STATE ST. P.O. BOX 2100
MONTPELIER VT
05601-2100
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-2562
  • Fax:
Mailing address:
  • Phone: 802-229-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000874
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number0890000874
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0890000874
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: