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NPI Code Detail

MEDICARE: GRACE MARIE MIGNOSA LICSW

MEDICARE: GRACE MARIE MIGNOSA LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0890000584VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043328180
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE MARIE MIGNOSA LICSW
Provider Business Mailing Address
First Line : 208 FLYNN AVE
Second Line : SUITE 3J
City : BURLINGTON
State : VT
Zip : 05401-5429
Country : US
Telephone Number : 802-488-6900
Fax Number : 802-488-6919
Provider Business Practice Location Address
First Line : 1138 PINE ST
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-5353
Country : US
Telephone Number : 802-488-6600
Fax Number : 802-488-6919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2006
Last Update Date : 02/10/2012

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Directions to “ GRACE MARIE MIGNOSA LICSW” Practice Location

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