MEDICARE: JUDITH A STROM 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
1	1041C0700X	Clinical Social Worker	089-0001101	VT

Other Identifiers

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

General Provider Information

NPI Number	:	1144244427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH A STROM LICSW

Provider Business Mailing Address
First Line	:	PO BOX 14
Second Line	:
City	:	WILLIAMSVILLE
State	:	VT
Zip	:	05362-0014
Country	:	US
Telephone Number	:	802-257-7355
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 W RIVER RD
Second Line	:	SUITE # 3 SOUTH
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-9006
Country	:	US
Telephone Number	:	802-275-7087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/01/2013

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