Individual
MARY BISSONWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, LCMHC
Contact information
Practice address
297 SUMMER ST, ST JOHNSBURY, VT 05819
(802) 748-1682
(802) 748-0211
Mailing address
144 SOUTH MAIN ST, HARDWICK, VT 05843
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
068-0000391
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012109
—
VT
Enumeration date
01/16/2007
Last updated
07/08/2007
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