MEDICARE: LANA HAUBEN 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	0890000883	VT

General Provider Information

NPI Number	:	1275609604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANA HAUBEN LICSW

Provider Business Mailing Address
First Line	:	56 ELM ST
Second Line	:	P.O. BOX 143
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9642
Country	:	US
Telephone Number	:	802-362-5590
Fax Number	:	802-362-5192

Provider Business Practice Location Address
First Line	:	56 ELM ST
Second Line	:	STREET LEVEL
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9642
Country	:	US
Telephone Number	:	802-362-5590
Fax Number	:	802-362-5192

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	02/12/2009

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