| Water's Edge Psychotherapy And Wellness Center | |
|
47 Maple St Burlington VT 05401-4861 | |
| (802) 651-7807 | |
| Not Available |
| Full Name | Water's Edge Psychotherapy And Wellness Center |
|---|---|
| Speciality | Social Worker |
| Location | 47 Maple St, Burlington, Vermont |
| Authorized Official Name and Position | Linda Wackerman (PARTNER) |
| Authorized Official Contact | 2069634907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Water's Edge Psychotherapy And Wellness Center 47 Maple St Ste 331 Burlington VT 05401-5097 Ph: (206) 963-4907 | Water's Edge Psychotherapy And Wellness Center 47 Maple St Burlington VT 05401-4861 Ph: (802) 651-7807 |
| NPI Number | 1285055376 |
|---|---|
| Provider Enumeration Date | 12/17/2013 |
| Last Update Date | 02/25/2022 |
| Certification Date | 02/25/2022 |
| Medicare PECOS PAC ID | 8426281197 |
|---|---|
| Medicare Enrollment ID | O20140502001687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285055376 | NPI | - | NPPES |
| 1006773 | Medicaid | VT | |
| 1018888 | Medicaid | VT | |
| 1285055376 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Vermont) | Secondary |
| 1041C0700X | Social Worker - Clinical | (Vermont) | Primary |
| Provider Name | Linda A Wackerman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770596447 PECOS PAC ID: 4880699255 Enrollment ID: I20110523000197 |
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