Nicholas Grudev, LCMHC
Individual provider Active NPI Mental Health Counselor · Sheldon, VT
NPI 1053955773 · NPPES record last updated Jan 6, 2025
Key facts
- NPI
- 1053955773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 068.0134184 (VT)
- Practice address
- 4038 Pond Rd
Sheldon, VT 05483-8390 - Phone
- (203) 300-7679
- NPI assigned
- Nov 6, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240221002988 | VT | Practitioner - Mental Health Counselor | 4486098183 | Practice locations: Sheldon, VT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 068.0134184 | VT | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 068.0134184 | VT | Yes |
Addresses
Primary practice location
4038 Pond Rd
Sheldon, VT 05483-8390
Mailing address
4038 Pond Rd
Sheldon, VT 05483-8390
Phone (203) 300-7679
Other providers in Sheldon, VT
All providers in Sheldon, VT · Mental Health Counselor in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.