Healthcare Provider Details

I. General information

NPI: 1104125699
Provider Name (Legal Business Name): BRENNA THERESE CORRIGAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST MAIL CODE 170/WMF
WHITE RIVER JUNCTION VT
05009-0001
US

IV. Provider business mailing address

215 N MAIN ST MAIL CODE 170/WMF
WHITE RIVER JUNCTION VT
05009-0001
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9363
  • Fax: 802-296-6416
Mailing address:
  • Phone: 802-295-9363
  • Fax: 802-296-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0075402
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: