Healthcare Provider Details

I. General information

NPI: 1487567103
Provider Name (Legal Business Name): CLARA CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MONROE ST
MIDDLEBURY VT
05753-1345
US

IV. Provider business mailing address

1061 DOWNINGSVILLE RD
LINCOLN VT
05443-9142
US

V. Phone/Fax

Practice location:
  • Phone: 802-989-6079
  • Fax:
Mailing address:
  • Phone: 802-349-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0136326
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: