Basic Information
| Provider Information | |||||||||
| NPI: | 1942308028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUGBEE | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 FLORAL ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054033000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026608393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 617 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028646309 | ||||||||
| FaxNumber: | 8028604324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0890000407 | VT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 374165 | 01 | MVP | OTHER | 28119 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 2041724 | 01 | CIGNA BEHAVIORAL HEALTH | OTHER | 079597 | 01 | VALUE OPTIONS | OTHER | 1007510 | 05 | VT | MEDICAID |