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Individual
DRIFT E MAVYN
Active
Individual
DRIFT E MAVYN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
MSW, LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.0134630
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5212947
BCBS VERMONT
VT
05
—
6712069
—
VT
01
—
MVP0551
MVP INSURANCE
VT
Enumeration date
05/09/2022
Last updated
10/03/2024
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