Individual
CAROLYN GILLIS LIBERTY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
89 MAIN ST, MIDDLEBURY, VT 05753-1459
(802) 388-6751
Mailing address
PO BOX 1045, MIDDLEBURY, VT 05753-5045
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0001139
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015393
—
VT
Enumeration date
03/09/2007
Last updated
08/13/2015
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