Healthcare Provider Details

I. General information

NPI: 1841566296
Provider Name (Legal Business Name): ELIZABETH A BIANCHI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 ROUTE 30
NEWFANE VT
05345
US

IV. Provider business mailing address

390 RIVER ST
SPRINGFIELD VT
05156-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-6028
  • Fax:
Mailing address:
  • Phone: 802-886-4500
  • Fax: 802-886-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0890000545
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0000545
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: