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General NPI Number Information
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NPI Number | 1578739140
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Entity Type | Individual
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Provider Name | JAIME E LIPKA LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 195 INDUSTRIAL PKWY STE 1
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City | LYNDONVILLE
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State | VT
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Zip | 05851-4511
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Country | US
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Telephone | 802-748-9501
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Fax | 802-748-3420
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Provider Business Mailing Address
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Address Line | PO BOX 905
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-0905
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Country | US
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Telephone | 802-748-9501
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Fax | 802-748-3420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 089-0001216
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0001216
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License Number State | VT
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