# TAGE LILJA LICSW PLC

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

## Provider details

- **NPI number:** 1972076339
- **Authorized official:** TAGE LILJA LICSW (OWNER)
- **Authorized official phone:** (802) 391-9865

## Contact information

- **Practice address:** 125 SAINT PAUL ST STE 107, BURLINGTON, VT 05401-8462
- **Practice address phone:** (802) 391-9865
- **Mailing address:** 391 SOUTHWIND RD, HINESBURG, VT 05461-4448
- **Mailing address phone:** (802) 391-9865

## Taxonomy

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

## Other

- **Enumeration date:** 01/09/2019
- **Last updated:** 07/30/2019