Leora Elizabeth Black, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

068-0000067 Issued in VT

Practice address

525 Hercules Dr
Suite 1a
Colchester, VT 05446-5993

Phone

(802) 264-5333

Fax

(802) 264-5338

NPI assigned

Nov 9, 2006

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 13, 2023.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1003986407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 COUNTRY MDWS",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054467072",
            "telephone_number": "802-264-5333",
            "fax_number": "802-264-5338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 HERCULES DR",
            "address_2": "SUITE 1A",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054465993",
            "telephone_number": "802-264-5333",
            "fax_number": "802-264-5338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "LEORA",
        "middle_name": "ELIZABETH",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "068-0000067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006789",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Benoit, OTR/L
• Michael C Bergeron, LCMHC
• Paul Vincent Bertocci, MD
• Rebecca Lynne Bissonette, P.T.
• Timothy Bissonette, PT
• Courtney Bliese, DC
• Anna M Bolanis, DDS
• Jessica Jean Bolduc, OT
• Nicole Bonneau
• Lindsey Bonsall, OTR

• All providers in Colchester, VT
• Mental Health Counselor in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.