Provider Demographics
NPI:1578739140
Name:LIPKA, JAIME E (LICSW)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:E
Last Name:LIPKA
Suffix:
Gender:F
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:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-0905
Mailing Address - Country:US
Mailing Address - Phone:802-748-9501
Mailing Address - Fax:802-748-3420
Practice Address - Street 1:195 INDUSTRIAL PKWY STE 1
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-4511
Practice Address - Country:US
Practice Address - Phone:802-748-9501
Practice Address - Fax:802-748-3420
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-0001216104100000X
VT089.00012161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075319Medicaid
VT1014894Medicaid
VT000587002Medicare PIN