Healthcare Provider Details

I. General information

NPI: 1336187954
Provider Name (Legal Business Name): ROBERT L. MUNGER M.A., LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PATCHEN RD
SOUTH BURLINGTON VT
05403-5704
US

IV. Provider business mailing address

34 PATCHEN RD
SOUTH BURLINGTON VT
05403-5704
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-4208
  • Fax: 802-658-2234
Mailing address:
  • Phone: 802-658-4208
  • Fax: 802-658-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0127838
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0680000564
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: