Provider Demographics
NPI:1316059579
Name:COOMBS, LAURIE A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:COOMBS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:COOMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LICSW
Mailing Address - Street 1:46 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-2327
Mailing Address - Country:US
Mailing Address - Phone:802-282-1786
Mailing Address - Fax:
Practice Address - Street 1:120 MERCHANTS ROW
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5911
Practice Address - Country:US
Practice Address - Phone:802-282-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00484151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical