Provider Demographics
NPI:1194930602
Name:ADAMS, PENNY SIMPSON
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:SIMPSON
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC LCMHC
Mailing Address - Street 1:106 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-8812
Mailing Address - Country:US
Mailing Address - Phone:802-387-5789
Mailing Address - Fax:802-387-4550
Practice Address - Street 1:114 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-8812
Practice Address - Country:US
Practice Address - Phone:802-387-8548
Practice Address - Fax:802-387-2550
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT068-0000483OtherSTATE LICENCE NO.