Healthcare Provider Details

I. General information

NPI: 1700336252
Provider Name (Legal Business Name): KATHERINE MCLEAN HOAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2016
Last Update Date: 10/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W TWIN OAKS TER UNIT 12, SUITE 5
SOUTH BURLINGTON VT
05403-7140
US

IV. Provider business mailing address

54 W TWIN OAKS TER UNIT 12, SUITE 5
SOUTH BURLINGTON VT
05403-7140
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-0830
  • Fax:
Mailing address:
  • Phone: 802-448-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0116286
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: