Provider Demographics
NPI:1295966406
Name:LAPORTE, OLIVIA W (LICSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:W
Last Name:LAPORTE
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 118
Mailing Address - Street 2:
Mailing Address - City:ENOSBURG FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05450-0118
Mailing Address - Country:US
Mailing Address - Phone:802-370-0344
Mailing Address - Fax:802-933-7100
Practice Address - Street 1:73 MAIN ST
Practice Address - Street 2:
Practice Address - City:ENOSBURG FALLS
Practice Address - State:VT
Practice Address - Zip Code:05450-5001
Practice Address - Country:US
Practice Address - Phone:802-933-4732
Practice Address - Fax:802-933-7100
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900012881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical