Active NPI
John E. Roberts, LCMHC
- Mental Health Counselor
- Burlington, VT
National Provider Identifier
1114064078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 068-0000696
- Practice address
- 34 Elmwood Ave
Burlington, VT 05401-4346 - Phone
- (802) 922-5935
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 068-0000696 | VT | Primary |
Addresses
Primary practice location
34 Elmwood Ave
Burlington, VT 05401-4346
Mailing address
34 Elmwood Ave
Burlington, VT 05401-4346
Phone (802) 922-5935
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0680000696 | Other | VT | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 2, 2024 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 068-0000696 | VT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703635200000",
"number": "1114064078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 ELMWOOD AVE",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054014346",
"telephone_number": "802-922-5935",
"fax_number": "802-857-0176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 ELMWOOD AVE",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054014346",
"telephone_number": "802-922-5935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JOHN",
"middle_name": "E.",
"credential": "LCMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2023-12-27",
"certification_date": "2023-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "068-0000696",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "0680000696",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.