MEDICARE: GABRIELLE JENSEN MSW

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	097.0135706	VT

General Provider Information

NPI Number	:	1619846144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE JENSEN MSW

Provider Business Mailing Address
First Line	:	3979 MOUNTAIN RD
Second Line	:
City	:	BRISTOL
State	:	VT
Zip	:	05443-9227
Country	:	US
Telephone Number	:	802-377-1868
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 CREEK RD
Second Line	:
City	:	MIDDLEBURY
State	:	VT
Zip	:	05753-1574
Country	:	US
Telephone Number	:	802-377-1868
Fax Number	:

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

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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