Individual
MS. KERRY V STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
145 PINE HAVEN SHORES RD, SHELBURNE, VT 05482-7703
(802) 316-4135
Mailing address
PO BOX 3330, BURLINGTON, VT 05408-9330
(802) 777-9382
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890073009
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
089-0073009
LICSW LICENSE #
VT
01
—
12301331
CAQH PROVIDER ID
—
Enumeration date
12/06/2011
Last updated
08/23/2024
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