MEDICARE: MS. ELIZABETH JEAN ROMEKA-PLUTA LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	089-0000243	VT
2	1041C0700X	Clinical Social Worker	089-0000 243	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11304678	OTHER	VT	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851580799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH JEAN ROMEKA-PLUTA LICSW

Provider Business Mailing Address
First Line	:	73 HIGH ST.
Second Line	:
City	:	PROCTOR
State	:	VT
Zip	:	05765
Country	:	US
Telephone Number	:	802-353-7256
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 MAIN STREET
Second Line	:
City	:	POULTNEY
State	:	VT
Zip	:	05764
Country	:	US
Telephone Number	:	802-353-7256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	09/06/2012

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