| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 36 Back St, Newfane, Vermont |
| Authorized Official Name and Position | Ingrid Scholz Longo (PRESIDENT) |
| Authorized Official Contact | 8023657111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
36 Back St Newfane VT 05345-9523 Ph: (802) 365-7111 | 36 Back St Newfane VT 05345-9523 Ph: (802) 365-7111 |
| NPI Number | 1932404266 |
|---|---|
| Provider Enumeration Date | 01/18/2011 |
| Last Update Date | 07/07/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932404266 | NPI | - | NPPES |
| 0VN1736 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 477 (Vermont) | Primary |