Basic Information
| Provider Information | |||||||||
| NPI: | 1609426162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUILLETTE | ||||||||
| FirstName: | BRANDY | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 FREEMAN AVE | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027704370 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 STRATTON RD | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027733386 | ||||||||
| FaxNumber: | 8027734578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2019 | ||||||||
| LastUpdateDate: | 10/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 089.0126825 | VT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.