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NPI Code Detail

MEDICARE: MATT MACAULAY LICSW LLC

MEDICARE: MATT MACAULAY LICSW LLC
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 Worker

General Provider Information

NPI Number : 1346955309
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATT MACAULAY LICSW LLC
Provider Business Mailing Address
First Line : 5 BANK ST
Second Line :
City : NORTH BENNINGTON
State : VT
Zip : 05257-9102
Country : US
Telephone Number : 802-294-2983
Fax Number :
Provider Business Practice Location Address
First Line : 5 BANK ST
Second Line :
City : NORTH BENNINGTON
State : VT
Zip : 05257-9102
Country : US
Telephone Number : 802-294-2983
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MATT MACAULAY MACAULAY
Credential : LICSW
Telephone Number : 802-294-2983
Provider Enumeration Date : 01/13/2023
Last Update Date : 01/14/2023

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