Healthcare Provider Details

I. General information

NPI: 1740342559
Provider Name (Legal Business Name): VICTORIA RHODIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 VT RTE 14 OFFICE 6
SHARON VT
05065
US

IV. Provider business mailing address

PO BOX 156
SHARON VT
05065-0156
US

V. Phone/Fax

Practice location:
  • Phone: 802-291-9001
  • Fax: 802-291-9001
Mailing address:
  • Phone: 802-291-9001
  • Fax: 802-291-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89-0000457
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: