Individual
SUSAN IDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
47 MAPLE ST STE 302-304, BURLINGTON, VT 05401-4861
(802) 373-2851
Mailing address
47 MAPLE ST STE 302-304, BURLINGTON, VT 05401-4861
(802) 373-2851
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890077028
VT
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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