Provider Demographics
NPI:1306842125
Name:LOEFFLER, CAROL A (PHD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:LOEFFLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:LAYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:82 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9642
Mailing Address - Country:US
Mailing Address - Phone:802-867-7035
Mailing Address - Fax:802-367-1069
Practice Address - Street 1:82 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9642
Practice Address - Country:US
Practice Address - Phone:802-867-7035
Practice Address - Fax:802-367-1069
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5201103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP620004623OtherRR MEDICARE
VT1024899Medicaid
OH281743OtherTRICARE CHAMPUS
OH5949417OtherAETNA
OH03818OtherPARAMOUNT HEALTHCARE
OH2015796Medicaid
OH271070000OtherMAGELLAN
OH000000325622OtherANTHEM BC
OHS59198Medicare UPIN
VT1024899Medicaid
OH271070000OtherMAGELLAN