| Amy Breese, Licsw, Llc | |
|
937 Gage St Bennington VT 05201-2069 | |
| (518) 469-8704 | |
| Not Available |
| Full Name | Amy Breese, Licsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 937 Gage St, Bennington, Vermont |
| Authorized Official Name and Position | Amy Breese (PROVIDER) |
| Authorized Official Contact | 5184698704 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Breese, Licsw, Llc 937 Gage St Bennington VT 05201-2069 Ph: (518) 469-8704 | Amy Breese, Licsw, Llc 937 Gage St Bennington VT 05201-2069 Ph: (518) 469-8704 |
| NPI Number | 1013594662 |
|---|---|
| Provider Enumeration Date | 03/28/2021 |
| Last Update Date | 03/28/2021 |
| Certification Date | 03/28/2021 |
| Medicare PECOS PAC ID | 1951719608 |
|---|---|
| Medicare Enrollment ID | O20210416001443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013594662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amy Breese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942524533 PECOS PAC ID: 7719233287 Enrollment ID: I20180713001261 |
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