Individual
MS. MARY CLAIRE DEHAVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
63 MAPLE ST, MIDDLEBURY, VT 05753-1602
(802) 349-7095
Mailing address
1006 JERUSALEM RD, BRISTOL, VT 05443-5326
(802) 349-7095
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890000439
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007733
—
VT
01
—
2031021
CIGNA
VT
01
—
38212
BLUE CROSS BLUE SHIELD
VT
01
—
411V121
MVP
VT
01
—
4128154
UNITED BEHAVIORAL HEALTH
VT
Enumeration date
05/08/2007
Last updated
07/09/2007
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