Individual ProviderColleen DwyerSocial WorkerBehavioral Health & Social Service ProvidersPractice Address617 Riverside Ave, Burlington, VT 05401-1601(802) 864-6309(802) 862-8172PECOS EnrollmentBased on the most recent information from CMS, provider Colleen Dwyer does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1164523080Provider TypeIndividualFull NameDwyer, ColleenCredentialLICSWGenderFemaleSole ProprietorNoEnumeration Date9/25/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address617 Riverside Ave, Burlington, VT 05401-1601Phone(802) 864-6309Fax(802) 860-4324Mailing LocationMailing Address81 Willard Street, Burlington, VT 05401Phone(802) 862-8172FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense0890000995VermontProvider IdentifiersIDDescriptionIssuerID576759DescriptionOtherIssuerVALUE OPTIONSID1010437DescriptionMedicaidIssuerUnlistedVermontID2202425DescriptionOtherIssuerCIGNA BEHAVIORAL HEALTHID68164DescriptionOtherIssuerBLUE CROSS BLUE SHIELDVermont