Individual
GRACE MARIE MIGNOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1138 PINE ST, BURLINGTON, VT 05401-5353
(802) 488-6600
(802) 488-6919
Mailing address
208 FLYNN AVE, SUITE 3J, BURLINGTON, VT 05401-5429
(802) 488-6900
(802) 488-6919
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890000584
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012149
—
VT
Enumeration date
08/28/2006
Last updated
02/10/2012
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