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NPI Code Detail

MEDICARE: JAIME E LIPKA LICSW

MEDICARE: JAIME E LIPKA 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
1104100000XSocial Worker089-0001216VT
21041C0700XClinical Social Worker089.0001216VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578739140
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIME E LIPKA LICSW
Provider Business Mailing Address
First Line : PO BOX 905
Second Line :
City : ST JOHNSBURY
State : VT
Zip : 05819-0905
Country : US
Telephone Number : 802-748-9501
Fax Number : 802-748-3420
Provider Business Practice Location Address
First Line : 195 INDUSTRIAL PKWY STE 1
Second Line :
City : LYNDONVILLE
State : VT
Zip : 05851-4511
Country : US
Telephone Number : 802-748-9501
Fax Number : 802-748-3420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2008
Last Update Date : 03/18/2022

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Directions to “ JAIME E LIPKA LICSW” Practice Location

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