| Drift Mavyn Licsw Llc | |
|
38 Park Pl Brattleboro VT 05301-2827 | |
| (802) 321-5066 | |
| (802) 210-3972 |
| Full Name | Drift Mavyn Licsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 38 Park Pl, Brattleboro, Vermont |
| Authorized Official Name and Position | Drift E Mavyn (OWNER) |
| Authorized Official Contact | 8023215066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Drift Mavyn Licsw Llc Po Box 1607 Brattleboro VT 05302-1607 Ph: (802) 321-5066 | Drift Mavyn Licsw Llc 38 Park Pl Brattleboro VT 05301-2827 Ph: (802) 321-5066 |
| NPI Number | 1134842909 |
|---|---|
| Provider Enumeration Date | 09/26/2022 |
| Last Update Date | 12/15/2023 |
| Certification Date | 12/15/2023 |
| Medicare PECOS PAC ID | 0648640367 |
|---|---|
| Medicare Enrollment ID | O20221221000950 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134842909 | NPI | - | NPPES |
| MVP0551 | Other | VT | MVP INSURANCE |
| 5212947 | Other | VT | BCBS VERMONT |
| 6712069 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Drift E Mavyn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316683758 PECOS PAC ID: 1557731270 Enrollment ID: I20221221001169 |
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