| Tage Lilja Licsw Plc | |
|
125 Saint Paul St Ste 107 Burlington VT 05401-8462 | |
| (802) 391-9865 | |
| Not Available |
| Full Name | Tage Lilja Licsw Plc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 125 Saint Paul St Ste 107, Burlington, Vermont |
| Authorized Official Name and Position | Tage Lilja (OWNER) |
| Authorized Official Contact | 8023919865 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tage Lilja Licsw Plc 391 Southwind Rd Hinesburg VT 05461-4448 Ph: (802) 391-9865 | Tage Lilja Licsw Plc 125 Saint Paul St Ste 107 Burlington VT 05401-8462 Ph: (802) 391-9865 |
| NPI Number | 1972076339 |
|---|---|
| Provider Enumeration Date | 01/09/2019 |
| Last Update Date | 07/30/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972076339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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