Organization
DRIFT MAVYN LICSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DRIFT E MAVYN MSW, LICSW (OWNER)
(802) 321-5066
Entity
Organization
Contact information
Practice address
74 GRAFTON RD., TOWNSHEND, VT 05353
(802) 321-5066
(802) 210-3972
Mailing address
PO BOX 157, TOWNSHEND, VT 05353-0157
(802) 321-5066
(802) 210-3972
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5212947
BCBS VERMONT
VT
05
—
6712069
—
VT
01
—
MVP0551
MVP INSURANCE
VT
Enumeration date
09/26/2022
Last updated
10/03/2024
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