Provider Demographics
NPI:1659117927
Name:MARY M FONDRIEST LLC
Entity type:Organization
Organization Name:MARY M FONDRIEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:FONDRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:802-595-9930
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-0301
Mailing Address - Country:US
Mailing Address - Phone:802-595-9930
Mailing Address - Fax:
Practice Address - Street 1:1225 VT-15
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:VT
Practice Address - Zip Code:05680
Practice Address - Country:US
Practice Address - Phone:802-595-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty