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Contact Information

DRIFT MAVYN LICSW LLC
74 GRAFTON RD.
TOWNSHEND, VT05353
 Phone: 802-321-5066
 Fax: 802-210-3972
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for DRIFT MAVYN LICSW LLC

NPI Number 1134842909
LBN Legal business name DRIFT MAVYN LICSW LLC
Authorized official DRIFT MAVYN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/26/2022
Last updated 10/03/2024 - More than a year ago
Identifiers
VT Medicaid 6712069
VT Other 5212947 BCBS VERMONT
VT Other MVP0551 MVP INSURANCE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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