Provider Demographics
NPI:1184090128
Name:RICHARD DOUCET LICSW LLC
Entity type:Organization
Organization Name:RICHARD DOUCET LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUCET
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:802-246-1221
Mailing Address - Street 1:36 PARK PL STE 101
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2802
Mailing Address - Country:US
Mailing Address - Phone:802-246-1221
Mailing Address - Fax:802-246-1002
Practice Address - Street 1:36 PARK PL STE 101
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2802
Practice Address - Country:US
Practice Address - Phone:802-246-1221
Practice Address - Fax:802-246-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.006747011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018900Medicaid