Healthcare Provider Details

I. General information

NPI: 1811807290
Provider Name (Legal Business Name): HENRY MARTIN MOONEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 MAIN ST
BURLINGTON VT
05401-8349
US

IV. Provider business mailing address

37 THERESA WAY
HINESBURG VT
05461
US

V. Phone/Fax

Practice location:
  • Phone: 802-242-2624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0137066
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: