Healthcare Provider Details

I. General information

NPI: 1205908985
Provider Name (Legal Business Name): MONIQUE BEDARD MS, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHURCH ST SUITE 2-C
BURLINGTON VT
05401-4299
US

IV. Provider business mailing address

2 CHURCH ST SUITE 2-C
BURLINGTON VT
05401-4299
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-8132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0000521
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: