# DRIFT MAVYN LICSW LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134842909
- **Authorized official:** DRIFT E MAVYN MSW, LICSW (OWNER)
- **Authorized official phone:** (802) 321-5066

## Contact information

- **Practice address:** 74 GRAFTON RD., TOWNSHEND, VT 05353
- **Practice address phone:** (802) 321-5066
- **Practice address fax:** (802) 210-3972
- **Mailing address:** PO BOX 157, TOWNSHEND, VT 05353-0157
- **Mailing address phone:** (802) 321-5066
- **Mailing address fax:** (802) 210-3972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2022
- **Last updated:** 10/03/2024