Healthcare Provider Details

I. General information

NPI: 1144040742
Provider Name (Legal Business Name): SAMARA R. COBLE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 GRANGER RD STE 2
BARRE VT
05641-5352
US

IV. Provider business mailing address

PO BOX 66
EAST CALAIS VT
05650-0066
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-5810
  • Fax:
Mailing address:
  • Phone: 802-249-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089.0135045
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0135045
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: