Bridget Leicester, LICSW
Individual provider Active NPI Clinical Social Worker · Rutland, VT
NPI 1063448694 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1063448694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 089-0000928 (VT)
- Practice address
- 90 Mahoney Ave
Psychiatry & Psychotherapy Assocs
Rutland, VT 05701-0000 - Phone
- (802) 775-2581
- Fax
- (802) 775-3395
- NPI assigned
- Jun 24, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R042998-1 | NY | MD | Clinical Social Worker |
| 089-0000928 | VT | MD | Clinical Social Worker |
| 042998 | NY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089-0000928 | VT | Yes |
| Clinical Social Worker | 1041C0700X | R042998-1 | NY |
Addresses
Primary practice location
90 Mahoney Ave
Psychiatry & Psychotherapy Assocs
Rutland, VT 05701-0000
Mailing address
PO Box 305
Proctorsville, VT 05153-0000
Phone (802) 226-7450
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01562610 | Medicaid | NY | |
| 59551 | Other | VT | BL CR BL SH OF VT |
| 1009403 | Medicaid | VT | |
| 412173 | Other | VT | MVP |
Other providers in Rutland, VT
- Michael Edward Lawrie
- Keri Layton
- Leb Counseling and Wellness, LLC
- Michael Evan Lees
- Miki-Lynn Lehoisky
- Leif Erickson, OD, LLC
- Lenco Inc.
- Timothy J Lensing
- Justine Mary Lercara
- Becky Lynn Lewis
All providers in Rutland, VT · Clinical Social Worker in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.