| Licia Berry-berard, Msw, Licsw Llc | |
|
321 Route 113 Thetford VT 05054 | |
| (802) 565-0424 | |
| Not Available |
| Full Name | Licia Berry-berard, Msw, Licsw Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 321 Route 113, Thetford, Vermont |
| Authorized Official Name and Position | Licia Lane Berry-berard (OWNER) |
| Authorized Official Contact | 8026982246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Licia Berry-berard, Msw, Licsw Llc Po Box 44 North Thetford VT 05054-0044 Ph: (802) 698-2246 | Licia Berry-berard, Msw, Licsw Llc 321 Route 113 Thetford VT 05054 Ph: (802) 565-0424 |
| NPI Number | 1124891809 |
|---|---|
| Provider Enumeration Date | 11/03/2023 |
| Last Update Date | 01/02/2024 |
| Medicare PECOS PAC ID | 1759733231 |
|---|---|
| Medicare Enrollment ID | O20240119003189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124891809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Licia Lane Berry-berard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225505381 PECOS PAC ID: 4183074990 Enrollment ID: I20231220000482 |
Little Rivers Health Care, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2689 Vt 113, Thetford, VT 05047 Phone: 802-222-3026 Fax: 802-222-5654 |