Individual
REGINA DENISE TRAILWEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
128 MERCHANTS ROW RM 605, RUTLAND, VT 05701-5909
(802) 773-1411
Mailing address
342 VT ROUTE 100, HANCOCK, VT 05748
(802) 767-9263
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0000723
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007305
—
VT
Enumeration date
11/20/2006
Last updated
07/09/2007
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