Provider Demographics
NPI:1558893545
Name:BERNARDI-SMITH, MOLLY (LCMHW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BERNARDI-SMITH
Suffix:
Gender:F
Credentials:LCMHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MAIN ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3242
Mailing Address - Country:US
Mailing Address - Phone:802-595-9229
Mailing Address - Fax:
Practice Address - Street 1:90 MAIN ST STE 310
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3242
Practice Address - Country:US
Practice Address - Phone:802-595-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0119344101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor