Active NPI
Alix Matty Gibson, LICSW
- Social Worker
- Saint Albans, VT
National Provider Identifier
1912178708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 0890000970
- Practice address
- 20 Houghton St
Suite 211
Saint Albans, VT 05478-2227 - Phone
- (802) 524-4953
- Fax
- (802) 527-5404
- NPI assigned
- Mar 19, 2008
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 0890000970 | VT | Primary |
Addresses
Primary practice location
20 Houghton St
Suite 211
Saint Albans, VT 05478-2227
Mailing address
20 Houghton St
Suite 211
Saint Albans, VT 05478-2227
Phone (802) 524-4953
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1009725 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0890000970 | VT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205884800000",
"number": "1912178708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 HOUGHTON ST",
"address_2": "SUITE 211",
"city": "SAINT ALBANS",
"state": "VT",
"postal_code": "054782227",
"telephone_number": "802-524-4953",
"fax_number": "802-527-5404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 HOUGHTON ST",
"address_2": "SUITE 211",
"city": "SAINT ALBANS",
"state": "VT",
"postal_code": "054782227",
"telephone_number": "802-524-4953",
"fax_number": "802-527-5404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "ALIX",
"middle_name": "MATTY",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-19",
"last_updated": "2008-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "VT",
"license": "0890000970",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1009725",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Albans, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.