Provider Demographics
NPI:1760470256
Name:MCDOWELL, MARY K (MA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:156 COLLEGE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8423
Mailing Address - Country:US
Mailing Address - Phone:802-651-7680
Mailing Address - Fax:802-860-0183
Practice Address - Street 1:156 COLLEGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8423
Practice Address - Country:US
Practice Address - Phone:802-651-7680
Practice Address - Fax:802-860-0183
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000595103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004899Medicaid
VT19982OtherBCBS
MC-VN3717Medicare ID - Type Unspecified