Carolyn Gillis Liberty I, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089-0001139 Issued in VT

Practice address

89 Main St
Middlebury, VT 05753-1459

Phone

(802) 388-6751

NPI assigned

Mar 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carolyn Mercier Gillis Former name

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

Specialty

Clinical Social Worker

Education

University of Vermont College of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Counseling Service of Addison County IncGroup PAC ID 2062304439, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Counseling Service of Addison County, Inc

  • Clinic/Center
  • Middlebury, VT
  • NPI 1336278985

  VT

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439424000000",
    "number": "1750413639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1045",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057535045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 MAIN ST",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057531459",
            "telephone_number": "802-388-6751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBERTY",
        "first_name": "CAROLYN",
        "middle_name": "GILLIS",
        "name_suffix": "I",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2015-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089-0001139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015393",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "GILLIS",
            "middle_name": "MERCIER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Linn Larson, MD
• Clyde Lavallee
• Jason John Lebeau, P.T.
• Peter Lebenbaum
• Christopher Leonard, MSW, LICSW, LCSW
• Edward Lewis Lieberman
• Liminal Space Psychotherapy PLLC
• Lisa Pippa Alexander, MD PLC
• Nicole Litchfield
• Amy Voishan Littlefield, N.D.,LAC

• All providers in Middlebury, VT
• Clinical Social Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; 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.

Verify at the official NPI Registry.