Individual
NORTH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
278 MAIN ST, BURLINGTON, VT 05401-8336
(802) 864-2651
Mailing address
1191 NORTH AVE APT 309, BURLINGTON, VT 05408-2794
(409) 444-5750
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
156.0133976
VT
Other
Enumeration date
03/16/2023
Last updated
03/16/2023
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