Provider Demographics
NPI:1174689418
Name:BECKWITH, CAROLYN W (MED, LCMHC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:W
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:MED, LCMHC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:B
Other - Last Name:LAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:VT
Mailing Address - Zip Code:05733-8752
Mailing Address - Country:US
Mailing Address - Phone:802-558-3673
Mailing Address - Fax:
Practice Address - Street 1:104 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-8752
Practice Address - Country:US
Practice Address - Phone:802-558-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010137Medicaid