MEDICARE: CAROL A SIMS LCSW, PIP

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
1	1041C0700X	Clinical Social Worker	1271C	AL
2	1041C0700X	Clinical Social Worker	089-0001231	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051538599	OTHER	AL	BCBS OF ALABAMA NUMBER
2	051538836	OTHER	AL	BCBS FEDERAL NUMBER
3	PIP-401-1271C	OTHER	AL	PIP LICENSE
4	1271C	OTHER	AL	LCSW

General Provider Information

NPI Number	:	1225039134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A SIMS LCSW, PIP

Provider Business Mailing Address
First Line	:	P.O. BOX 83
Second Line	:
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851
Country	:	US
Telephone Number	:	802-748-9501
Fax Number	:	802-748-3420

Provider Business Practice Location Address
First Line	:	195 INDUSTRIAL PARKWAY
Second Line	:	NVRH CORNER MEDICAL
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851
Country	:	US
Telephone Number	:	802-748-9501
Fax Number	:	802-748-3420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/27/2014

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