Provider Demographics
NPI:1023693744
Name:FONDRIEST, MARY M (LCMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:FONDRIEST
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-0301
Mailing Address - Country:US
Mailing Address - Phone:802-323-1522
Mailing Address - Fax:802-323-1522
Practice Address - Street 1:1225 VT-15
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:VT
Practice Address - Zip Code:05680
Practice Address - Country:US
Practice Address - Phone:802-323-1522
Practice Address - Fax:802-323-1522
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134304101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health