Provider Demographics
NPI:1558369223
Name:SIMPSON, SCOTT D (LICSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:D
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BENTLEY LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-9631
Mailing Address - Country:US
Mailing Address - Phone:802-324-1401
Mailing Address - Fax:
Practice Address - Street 1:39 BENTLEY LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-9631
Practice Address - Country:US
Practice Address - Phone:802-324-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT890000339104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006701Medicaid
VT18701OtherBCBS OF VT
VT18701OtherBCBS OF VT