Active NPI
Leslie Diane Weed Fonner, LICSW
- Clinical Social Worker
- Berlin, VT
National Provider Identifier
1255513719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 089-0000523
- Practice address
- 174 Hospital Loop
Berlin, VT 05602-9105 - Phone
- (802) 479-4083
- Fax
- (802) 476-1476
- NPI assigned
- Nov 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089-0000523 | VT | Primary |
Addresses
Primary practice location
174 Hospital Loop
Berlin, VT 05602-9105
Mailing address
PO Box 647
Montpelier, VT 05601-0647
Phone (802) 479-4083
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410724 | Other | TRICARE | |
| 1042317 | Other | VT | CIGNA |
| 1255513719 | Other | VT | BLUE CROSS/BLUE SHIELD OF VERMONT |
| 989026C | Other | VT | MVP |
| 1014406 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089-0000523 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447891200000",
"number": "1255513719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 647",
"city": "MONTPELIER",
"state": "VT",
"postal_code": "056010647",
"telephone_number": "802-479-4083",
"fax_number": "802-476-1476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "174 HOSPITAL LOOP",
"city": "BERLIN",
"state": "VT",
"postal_code": "056029105",
"telephone_number": "802-479-4083",
"fax_number": "802-476-1476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEED FONNER",
"first_name": "LESLIE",
"middle_name": "DIANE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-27",
"last_updated": "2015-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "089-0000523",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "410724",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1042317",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD OF VERMONT",
"identifier": "1255513719",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "989026C",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1014406",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berlin, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.