MEDICARE: ELEANOR M MORRISSEY LCMHC

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	0680000235	VT

Other Identifiers

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

General Provider Information

NPI Number	:	1801957469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR M MORRISSEY LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:	111 MAIN ST
City	:	HYDE PARK
State	:	VT
Zip	:	05655-0159
Country	:	US
Telephone Number	:	802-888-6215
Fax Number	:	802-888-9474

Provider Business Practice Location Address
First Line	:	111 MAIN ST
Second Line	:
City	:	HYDE PARK
State	:	VT
Zip	:	05655-0159
Country	:	US
Telephone Number	:	802-888-6215
Fax Number	:	802-888-9474

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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