Healthcare Provider Details

I. General information

NPI: 1356904817
Provider Name (Legal Business Name): KARA DIBBLE MSW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 ROUTE 30
NEWFANE VT
05345
US

IV. Provider business mailing address

390 RIVER STREET
SPRINGFIELD VT
05156-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-365-7909
  • Fax: 802-365-6102
Mailing address:
  • Phone: 802-886-4500
  • Fax: 802-886-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06322500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number156.0133893
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: