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NPI Code Detail

MEDICARE: LAURA PHILIPPS LICSW

MEDICARE: LAURA PHILIPPS LICSW
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 Worker089.0129084VT

General Provider Information

NPI Number : 1336741289
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA PHILIPPS LICSW
Provider Business Mailing Address
First Line : PO BOX 63
Second Line :
City : ADAMANT
State : VT
Zip : 05640-0063
Country : US
Telephone Number : 802-595-3560
Fax Number :
Provider Business Practice Location Address
First Line : 162 ELM ST
Second Line :
City : MONTPELIER
State : VT
Zip : 05602-2896
Country : US
Telephone Number : 802-595-3560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2020
Last Update Date : 11/14/2020

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Directions to “ LAURA PHILIPPS LICSW” Practice Location

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