Provider Demographics
NPI:1902564909
Name:MAURA NYDEGGER LICSW PLLC
Entity Type:Organization
Organization Name:MAURA NYDEGGER LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAURA NYDEGGER LICSW
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYDEGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-349-8579
Mailing Address - Street 1:199 MAIN ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:VT
Mailing Address - Zip Code:05770-8807
Mailing Address - Country:US
Mailing Address - Phone:802-349-8579
Mailing Address - Fax:
Practice Address - Street 1:199 MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:VT
Practice Address - Zip Code:05770-8807
Practice Address - Country:US
Practice Address - Phone:802-349-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty