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NPI Code Detail

MEDICARE: MS. LYNN M REARDON LADC/MHC

MEDICARE: MS. LYNN M REARDON LADC/MHC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor000303VT
2101YM0800XMental Health Counselor068-0000449VT
3172V00000XCommunity Health Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200048433OTHERVTBC/BS

General Provider Information

NPI Number : 1174600860
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LYNN M REARDON LADC/MHC
Provider Business Mailing Address
First Line : PO BOX 222
Second Line :
City : RUTLAND
State : VT
Zip : 05702-0222
Country : US
Telephone Number : 802-775-2381
Fax Number :
Provider Business Practice Location Address
First Line : 78 S MAIN ST
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4594
Country : US
Telephone Number : 802-775-2381
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 10/31/2024

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