MEDICARE: MARY CARTER BRADSHAW MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	097.0135884	VT

General Provider Information

NPI Number	:	1598627812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CARTER BRADSHAW MSW

Provider Business Mailing Address
First Line	:	15 BRICKYARD RD
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-4443
Country	:	US
Telephone Number	:	802-735-4136
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 BRICKYARD RD
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-4443
Country	:	US
Telephone Number	:	802-735-4136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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