Provider Demographics
NPI:1487241089
Name:BECHTEL, MARY E (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BECHTEL
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:MORETOWN
Mailing Address - State:VT
Mailing Address - Zip Code:05660-9498
Mailing Address - Country:US
Mailing Address - Phone:269-873-1216
Mailing Address - Fax:
Practice Address - Street 1:89 CASTLE RD
Practice Address - Street 2:
Practice Address - City:MORETOWN
Practice Address - State:VT
Practice Address - Zip Code:05660-9498
Practice Address - Country:US
Practice Address - Phone:269-873-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010829591041C0700X
VT089.01294241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801082959Medicaid