MEDICARE: CAROL A LOEFFLER PHD

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	103T00000X	Psychologist	5201	OH
2	103TC0700X	Clinical Psychologist	5201	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P620004623	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	281743	OTHER	OH	TRICARE CHAMPUS
4	5949417	OTHER	OH	AETNA
5	03818	OTHER	OH	PARAMOUNT HEALTHCARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	271070000	OTHER	OH	MAGELLAN
8	000000325622	OTHER	OH	ANTHEM BC

General Provider Information

NPI Number	:	1306842125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A LOEFFLER PHD

Provider Business Mailing Address
First Line	:	82 ELM ST
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9642
Country	:	US
Telephone Number	:	802-867-7035
Fax Number	:	802-367-1069

Provider Business Practice Location Address
First Line	:	82 ELM ST
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9642
Country	:	US
Telephone Number	:	802-867-7035
Fax Number	:	802-367-1069

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	12/08/2015

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Directions to “ CAROL A LOEFFLER PHD” Practice Location

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