Provider Demographics
NPI:1851580799
Name:ROMEKA-PLUTA, ELIZABETH JEAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:ROMEKA-PLUTA
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 1:73 HIGH ST.
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:VT
Mailing Address - Zip Code:05765
Mailing Address - Country:US
Mailing Address - Phone:802-353-7256
Mailing Address - Fax:
Practice Address - Street 1:212 MAIN STREET
Practice Address - Street 2:
Practice Address - City:POULTNEY
Practice Address - State:VT
Practice Address - Zip Code:05764
Practice Address - Country:US
Practice Address - Phone:802-353-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00002431041C0700X
VT089-0000 2431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT11304678OtherCAQH
VTID1014360Medicaid
VTID1014360Medicaid