Active NPI
Carol Elissa Owen, LICSW
- Clinical Social Worker
- Fairlee, VT
National Provider Identifier
1124118302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 089.0135072
- Practice address
- 28 Lake Morey Rd Apt 2
Fairlee, VT 05045-9824 - Phone
- (207) 779-7635
- Fax
- (207) 779-7635
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089.0135072 | VT | Primary |
Addresses
Primary practice location
28 Lake Morey Rd Apt 2
Fairlee, VT 05045-9824
Mailing address
PO Box 15
Thetford, VT 05074-0015
Phone (207) 779-7635
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230424001604 | VT | Practitioner - Clinical Social Worker | 8628969912 | Practice locations: Thetford Center, VT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Thetford Center, VT 05075
Phone (207) 779-7635
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089.0135072 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710720000000",
"number": "1124118302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15",
"city": "THETFORD",
"state": "VT",
"postal_code": "050740015",
"telephone_number": "207-779-7635",
"fax_number": "978-356-2015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 LAKE MOREY RD APT 2",
"city": "FAIRLEE",
"state": "VT",
"postal_code": "050459824",
"telephone_number": "207-779-7635",
"fax_number": "207-779-7635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OWEN",
"first_name": "CAROL",
"middle_name": "ELISSA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2024-03-18",
"certification_date": "2024-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "089.0135072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairlee, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.