MEDICARE: HEATHER AXMAN L.C.S.W.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	151.0125990	VT
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MCAP.0100249	FL
3	1041C0700X	Clinical Social Worker	SW9437	FL
4	1041C0700X	Clinical Social Worker	079468	NY
5	1041C0700X	Clinical Social Worker	089.0082832	VT

General Provider Information

NPI Number	:	1386879674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER AXMAN L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	WILMINGTON
State	:	VT
Zip	:	05363-0051
Country	:	US
Telephone Number	:	954-554-2368
Fax Number	:	802-923-3912

Provider Business Practice Location Address
First Line	:	5 MOUNTAIN PARK PLAZA
Second Line	:
City	:	WEST DOVER
State	:	VT
Zip	:	05356-9999
Country	:	US
Telephone Number	:	802-464-8105
Fax Number	:	802-923-3912

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

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	11/17/2024

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