=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598838369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD J DUNWORTH LICSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 ALLEN ST
-----------------------------------------------------
City | RUTLAND
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05701-4560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-775-7111
-----------------------------------------------------
Fax | 802-747-6260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 PLEASANT ST EXT
-----------------------------------------------------
City | LUDLOW
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05149-9782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-228-2476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 0890000325
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------