Provider Demographics
NPI:1043790520
Name:WHITCOMB, ASA (LICSW)
Entity type:Individual
Prefix:
First Name:ASA
Middle Name:
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ASA
Other - Middle Name:
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 DUFFY DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-9585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:532 POTTER HILL RD
Practice Address - Street 2:
Practice Address - City:READSBORO
Practice Address - State:VT
Practice Address - Zip Code:05350
Practice Address - Country:US
Practice Address - Phone:802-681-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01183301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical