Stuart Moore Maccrellish, MSW
Individual provider Active NPI Clinical Social Worker · New Haven, VT
NPI 1134401433 · NPPES record last updated Sep 13, 2011
Key facts
- NPI
- 1134401433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 089.0000971 (VT)
- Practice address
- 653 Quarry Rd
New Haven, VT 05472-2028 - Phone
- (802) 989-2295
- NPI assigned
- Sep 13, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 089.0000971 | VT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089.0000971 | VT | Yes |
Addresses
Primary practice location
653 Quarry Rd
New Haven, VT 05472-2028
Mailing address
653 Quarry Rd
New Haven, VT 05472-2028
Other providers in New Haven, VT
- Dynamic Engagement Institute, L3C
- Michele Aaron Fouts
- Joan Sharon Johnson
- Rebecca Kennedy
- Amanda Locker
- Andrew R. Morton
- Theresa Anne Sawyer
All providers in New Haven, 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 Sep 13, 2011. 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.