Healthcare Provider Details

I. General information

NPI: 1295966406
Provider Name (Legal Business Name): OLIVIA W LAPORTE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MAIN ST
ENOSBURG FALLS VT
05450-5001
US

IV. Provider business mailing address

PO BOX 118
ENOSBURG FALLS VT
05450-0118
US

V. Phone/Fax

Practice location:
  • Phone: 802-933-4732
  • Fax: 802-933-7100
Mailing address:
  • Phone: 802-370-0344
  • Fax: 802-933-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0890001288
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: