=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871305037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA L GIBBS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 167 N MAIN ST
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05773-9800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-446-3577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 FURNACE ST
-----------------------------------------------------
City | POULTNEY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05764-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-673-6931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 089.0136856
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------