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136b Prospect St Brattleboro VT 05301-6465 | |
| (207) 560-6033 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 136b Prospect St, Brattleboro, Vermont |
| Authorized Official Name and Position | Tracey S Madigan (PROVIDER) |
| Authorized Official Contact | 2075606033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1691 Brattleboro VT 05302-1691 Ph: (207) 560-6033 | 136b Prospect St Brattleboro VT 05301-6465 Ph: (207) 560-6033 |
| NPI Number | 1245845130 |
|---|---|
| Provider Enumeration Date | 09/09/2020 |
| Last Update Date | 05/01/2024 |
| Certification Date | 05/01/2024 |
| Medicare PECOS PAC ID | 0244641082 |
|---|---|
| Medicare Enrollment ID | O20240122003903 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245845130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tracey S Madigan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376084921 PECOS PAC ID: 1153732995 Enrollment ID: I20240122004174 |
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