Individual provider Active NPI

Rosemarie Stackhouse, LICSW

  • Clinical Social Worker
  • Burlington, VT
National Provider Identifier
1083493365
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
089.0135533 Issued in VT
Practice address
267 Pearl St Ste 10
Burlington, VT 05401-8543
Phone
(802) 488-4612
NPI assigned
Sep 26, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 089.0135533 VT Primary

Addresses

Primary practice location

267 Pearl St Ste 10
Burlington, VT 05401-8543

Mailing address

267 Pearl St Ste 10
Burlington, VT 05401-8543
Phone (802) 488-4612

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231017003281 VT Practitioner - Clinical Social Worker 2062867641 Practice locations: Burlington, VT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

267 Pearl St
Suite 10
Burlington, VT 05401-8543
Phone (802) 488-4612

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
089.0135533VTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Annie Lawson Licsw LLC Clinical CurrentSince Oct 1, 2023 Accepting new patients

Locations

267 Pearl St
Ste 10
Burlington, VT 05401
Phone (802) 488-4612

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1083493365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 PEARL ST STE 10",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054018543",
            "telephone_number": "802-488-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 PEARL ST STE 10",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054018543",
            "telephone_number": "802-488-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "ROSEMARIE",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-26",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.0135533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.