| Mary M Fondriest Llc | |
|
1225 Vt-15 Wolcott VT 05680 | |
| (802) 595-9930 | |
| Not Available |
| Full Name | Mary M Fondriest Llc |
|---|---|
| Speciality | Counselor |
| Location | 1225 Vt-15, Wolcott, Vermont |
| Authorized Official Name and Position | Mary Margaret Fondriest (SOLE PROPRIETOR) |
| Authorized Official Contact | 8025959930 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary M Fondriest Llc Po Box 301 Hardwick VT 05843-0301 Ph: (802) 595-9930 | Mary M Fondriest Llc 1225 Vt-15 Wolcott VT 05680 Ph: (802) 595-9930 |
| NPI Number | 1659117927 |
|---|---|
| Provider Enumeration Date | 07/05/2024 |
| Last Update Date | 07/05/2024 |
| Certification Date | 06/27/2024 |
| Medicare PECOS PAC ID | 0749711158 |
|---|---|
| Medicare Enrollment ID | O20241009000523 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659117927 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mary Margaret Fondriest |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023693744 PECOS PAC ID: 7810347036 Enrollment ID: I20231229000646 |
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