Provider Demographics
NPI:1649648361
Name:POPE, MARION (LCAT, LCMHC, ATR-BC)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:LCAT, LCMHC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 COLLEGE ST STE H
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8344
Mailing Address - Country:US
Mailing Address - Phone:802-234-1508
Mailing Address - Fax:
Practice Address - Street 1:337 COLLEGE ST STE H
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8344
Practice Address - Country:US
Practice Address - Phone:802-234-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001909221700000X
VT068.0122426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1031805Medicaid