Jean Etter, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089-0000769 Issued in VT

Practice address

18 Old Terrace
The Windham Center
Bellow Falls, VT 05101

Phone

(802) 463-1292

NPI assigned

Jul 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Matrix Health Systems P.C.

  • Clinical Psychologist
  • Burlington, VT
  • NPI 1104872712
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619990827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 RIVER ST",
            "address_2": "C/O NETWORK MANAGEMENT SERVICES",
            "city": "SPRINGFIELD",
            "state": "VT",
            "postal_code": "051562306",
            "telephone_number": "802-885-5785",
            "fax_number": "802-885-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 OLD TERRACE",
            "address_2": "THE WINDHAM CENTER",
            "city": "BELLOW FALLS",
            "state": "VT",
            "postal_code": "05101",
            "telephone_number": "802-463-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTER",
        "first_name": "JEAN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089-0000769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN2603",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30420624",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George T Karabakakis, PHD
• Alexa Licata, MA

• Clinical Social Worker in Bellow Falls, VT
• Providers in Bellow Falls, VT by specialty
• Clinical Social Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.