Provider Demographics
NPI:1174233878
Name:DIETER, MARY JANE (MSW)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:DIETER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BACK FORTY LN
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05494-4000
Mailing Address - Country:US
Mailing Address - Phone:802-238-4512
Mailing Address - Fax:
Practice Address - Street 1:7 BACK FORTY LN
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:VT
Practice Address - Zip Code:05494-4000
Practice Address - Country:US
Practice Address - Phone:802-238-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00004541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical