Provider Demographics
NPI:1861402208
Name:NAYLOR, DORSEY T (LICSW)
Entity type:Individual
Prefix:
First Name:DORSEY
Middle Name:T
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WEAVER STREET
Mailing Address - Street 2:P.O. BOX 127 VERMONT CHILDREN'S AID SOCIETY
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-0127
Mailing Address - Country:US
Mailing Address - Phone:802-655-0006
Mailing Address - Fax:802-655-0073
Practice Address - Street 1:79 WEAVER STREET
Practice Address - Street 2:VERMONT CHILDREN'S AID SOCIETY
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-0127
Practice Address - Country:US
Practice Address - Phone:802-655-0006
Practice Address - Fax:802-655-0073
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900004371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008867Medicaid