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Individual

MS. NANCY JEAN ELLERY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
64 ALLEN ST, RUTLAND, VT 05701-4554
(802) 747-7296
Mailing address
64 ALLEN ST, RUTLAND, VT 05701-4554
(802) 747-7296
(802) 773-3965

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
089-0000259
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0VN1157
VT
01
18144
BLUE CROSS
VT
Enumeration date
10/21/2006
Last updated
06/15/2012
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