Individual
MS. BRIDGET LEICESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
90 MAHONEY AVE, PSYCHIATRY & PSYCHOTHERAPY ASSOCS, RUTLAND, VT 05701-0000
(802) 775-2581
(802) 775-3395
Mailing address
PO BOX 305, PROCTORSVILLE, VT 05153-0000
(802) 226-7450
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0000928
VT
1041C0700X
Clinical Social Worker
R042998-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01562610
—
NY
05
—
1009403
—
VT
01
—
412173
MVP
VT
01
—
59551
BL CR BL SH OF VT
VT
Enumeration date
06/24/2006
Last updated
07/08/2007
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