Active NPI
Jean Pollock, MHC, NCC
- Mental Health Counselor
- Brattleboro, VT
National Provider Identifier
1235186479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 068-0000009
- Practice address
- 229 Western Ave
Brattleboro, VT 05301-6589 - Phone
- (802) 257-1047
- Fax
- (802) 348-7277
- NPI assigned
- May 30, 2006
- Last updated
- Dec 16, 2010
- Sex
- Female
- 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 | 068-0000009 | VT | Primary |
Addresses
Primary practice location
229 Western Ave
Brattleboro, VT 05301-6589
Mailing address
229 Western Ave
Brattleboro, VT 05301-6589
Phone (802) 257-1047
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MAGELLAN: 50794000 | Other | VT | PROVIDER # |
| 1011069 | Medicaid | VT | |
| BCBSVT: 6191 | Other | VT | PROVIDER # |
| CQAH: 11325993 | Other | VT | UNIVERSAL CREDENTIALING |
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 16, 2024 through Jan 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 068-0000009 | VT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292457600000",
"number": "1235186479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "229 WESTERN AVE",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "053016589",
"telephone_number": "802-257-1047",
"fax_number": "802-348-7277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 WESTERN AVE",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "053016589",
"telephone_number": "802-257-1047",
"fax_number": "802-348-7277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLOCK",
"first_name": "JEAN",
"name_prefix": "Ms.",
"credential": "MHC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-30",
"last_updated": "2010-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "068-0000009",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER #",
"identifier": "MAGELLAN: 50794000",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1011069",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER #",
"identifier": "BCBSVT: 6191",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERSAL CREDENTIALING",
"identifier": "CQAH: 11325993",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brattleboro, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; 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.