MARY BISSONWARD LADC LCMHC NPI 1639221369

NPI Information

  • NPI: 1639221369
  • Provider Name: MARY BISSONWARD, LADC, LCMHC
  • Classification: Counselor - 101Y00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 297 SUMMER ST
    ST JOHNSBURY, VT
    ZIP 05819
  • Phone: (802) 748-1682

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NPI Details

Mary Bissonward, LADC, LCMHC is a counselor in St Johnsbury, VT. The provider is a provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification. Mary Bissonward, LADC, LCMHC NPI is 1639221369. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

297 SUMMER ST
ST JOHNSBURY, VT
ZIP 05819
Phone: (802) 748-1682
Fax: (802) 748-0211

The NPI 1639221369 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 1/16/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101Y00000XCounselor068-0000391VERMONTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11012109MEDICAIDVERMONT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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