Individual provider Active NPI

Kimberlee D. Johnson, MSW, LICSW

  • Clinical Social Worker
  • Montpelier, VT
National Provider Identifier
1245548379
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
089.0122238 Issued in VT
Practice address
28 E. State Street
Ste 8
Montpelier, VT 05602
Phone
(802) 933-1964
NPI assigned
Sep 23, 2010
Last updated
Feb 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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 089.0122238 VT Primary

Addresses

Primary practice location

28 E. State Street
Ste 8
Montpelier, VT 05602

Mailing address

PO Box 931
Montpelier, VT 05601-0931
Phone (802) 398-5317

Other identifiers 1

IdentifierTypeStateIssuer
1028186MedicaidVT

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
I20200225001125 VT Practitioner - Clinical Social Worker 0244402865 Practice locations: Montpelier, VT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

28 E State St
Suite 8
Montpelier, VT 05602-3071
Phone (802) 398-5317

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1245548379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 931",
            "city": "MONTPELIER",
            "state": "VT",
            "postal_code": "056010931",
            "telephone_number": "802-398-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 E. STATE STREET",
            "address_2": "STE 8",
            "city": "MONTPELIER",
            "state": "VT",
            "postal_code": "05602",
            "telephone_number": "802-933-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLEE",
        "middle_name": "D.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-23",
        "last_updated": "2021-02-04",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.0122238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028186",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montpelier, VT

Sources for this page

Verify at the official NPI Registry.