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NPI Code Detail

MEDICARE: CAROL W IPPOLITI LCSW

MEDICARE: CAROL W IPPOLITI LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLC5292ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205835550
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL W IPPOLITI LCSW
Provider Business Mailing Address
First Line : PO BOX 380
Second Line :
City : DOVER FOXCROFT
State : ME
Zip : 04426-0380
Country : US
Telephone Number : 207-564-7106
Fax Number : 207-564-0881
Provider Business Practice Location Address
First Line : 59 RIVER ST
Second Line :
City : DOVER FOXCROFT
State : ME
Zip : 04426-1322
Country : US
Telephone Number : 207-564-7106
Fax Number : 207-564-0881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/08/2007

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Directions to “ CAROL W IPPOLITI LCSW” Practice Location

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