Healthcare Provider Details

I. General information

NPI: 1386610012
Provider Name (Legal Business Name): ALICE SIEGRIEST LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 WEAVER ST VERMONT CHILDREN'S AID SOCIETY
WINOOSKI VT
05404-2038
US

IV. Provider business mailing address

79 WEAVER ST P.O. BOX 127
WINOOSKI VT
05404-2038
US

V. Phone/Fax

Practice location:
  • Phone: 802-655-0006
  • Fax: 802-655-0073
Mailing address:
  • Phone: 802-655-0006
  • Fax: 802-655-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0890000444
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: