Active NPI
Emmadora Boutcher
- Clinical Social Worker
- Dummerston, VT
National Provider Identifier
1396308409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 089.0137076
- Practice address
- 62 Riverside Dr
Dummerston, VT 05301-8928 - Phone
- (802) 822-2520
- NPI assigned
- Apr 16, 2019
- Last updated
- May 18, 2026
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089.0137076 | VT | Primary |
| Clinical Social Worker | 1041C0700X | 122182 | MA |
Addresses
Primary practice location
62 Riverside Dr
Dummerston, VT 05301-8928
Mailing address
62 Riverside Dr
Dummerston, VT 05301-8928
Phone (802) 822-2520
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122182 | MA | MD | Clinical Social Worker |
| 089.0137076 | VT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Weaving Waters LLC | Current | Accepting new patients | |
| Blue Square Counseling and Wellness Center, PLLC | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Adult Mental Health Clinic/Center
- Dummerston, VT
- NPI 1891630174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779062400000",
"number": "1396308409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 RIVERSIDE DR",
"city": "DUMMERSTON",
"state": "VT",
"postal_code": "053018928",
"telephone_number": "802-822-2520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 RIVERSIDE DR",
"city": "DUMMERSTON",
"state": "VT",
"postal_code": "053018928",
"telephone_number": "802-822-2520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTCHER",
"first_name": "EMMADORA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-16",
"last_updated": "2026-05-18",
"certification_date": "2026-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "089.0137076",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "122182",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dummerston, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.