=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902315336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARA NAISMITH RIVERS LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2017
-----------------------------------------------------
Last Update Date | 11/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 MAIN ST
-----------------------------------------------------
City | ESSEX JUNCTION
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05452-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-560-5212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 267 PEARL ST UNIT A3
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-8543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-616-4163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 089.0134740
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 24544
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------