Healthcare Provider Details

I. General information

NPI: 1225039134
Provider Name (Legal Business Name): CAROL A SIMS LCSW, PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 INDUSTRIAL PARKWAY NVRH CORNER MEDICAL
LYNDONVILLE VT
05851
US

IV. Provider business mailing address

P.O. BOX 83
LYNDONVILLE VT
05851
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-9501
  • Fax: 802-748-3420
Mailing address:
  • Phone: 802-748-9501
  • Fax: 802-748-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1271C
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0001231
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: