Provider Demographics
NPI:1144488016
Name:SWINDELL, SUSAN L (LPMA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:SWINDELL
Suffix:
Gender:F
Credentials:LPMA
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:SWINDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPMA
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-223-6328
Mailing Address - Fax:802-229-8004
Practice Address - Street 1:9 HEATON ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2489
Practice Address - Country:US
Practice Address - Phone:802-223-6328
Practice Address - Fax:802-229-8004
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VT047-0000737103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2589342OtherCIGNA
VT1015087Medicaid
VT1144488016OtherBLUE CROSS/BLUE SHIELD OF VERMONT
VT989026COtherMVP
VT2589342OtherCIGNA