| Doctor Name: | MS. DEMARIS TISDALE |
| NPI Number: | 1043339773 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S.W. |
| License Number: | 089-0000231 |
| Business Practice Address: | 69 Barre St Montpelier, VT - 056023504 |
| Business Phone Number: | 8022292770 |
| Business Fax Number: | |
| Mailing Address: | 1125 Snipe Ireland Rd, RICHMOND |
| State: | VT |
| Postal Code: | 054779691 |
| Phone Number: | 8024343941 |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 089-0000231 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |