Provider Demographics
NPI:1588730865
Name:BEDOR, SYLVIA B (LCMHC, LADC)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:B
Last Name:BEDOR
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-1513
Mailing Address - Country:US
Mailing Address - Phone:802-748-5364
Mailing Address - Fax:802-748-7289
Practice Address - Street 1:231 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1513
Practice Address - Country:US
Practice Address - Phone:802-748-5364
Practice Address - Fax:802-748-7289
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007314Medicaid
VT61550OtherMOHAWK VALLEY PLAN
NH30422292Medicaid
VT48560OtherBCBS LADC PROVIDER #
VT49280OtherBCBS LCMHC PROVIDER #
VT2088542OtherCIGNA