Healthcare Provider Details

I. General information

NPI: 1568320885
Provider Name (Legal Business Name): SOPHIE KATE HYNES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA DOMAN

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SAN REMO DR
SOUTH BURLINGTON VT
05403-6312
US

IV. Provider business mailing address

45 SAN REMO DR
SOUTH BURLINGTON VT
05403-6312
US

V. Phone/Fax

Practice location:
  • Phone: 802-951-0450
  • Fax: 802-652-2008
Mailing address:
  • Phone: 802-951-0450
  • Fax: 802-652-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0136854
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: