Provider Demographics
NPI:1992150759
Name:LAURIE ANNE COOMBS INC.
Entity type:Organization
Organization Name:LAURIE ANNE COOMBS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-282-1786
Mailing Address - Street 1:85 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3309
Mailing Address - Country:US
Mailing Address - Phone:802-282-1786
Mailing Address - Fax:802-747-0095
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:802-747-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00484151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018310Medicaid
VT0029313OtherMEDICARE PTAN