Active NPI
Philip Lightbear, MA LADC CADC
- Addiction (Substance Use Disorder) Counselor
- St Johnsburg, VT
National Provider Identifier
1548435696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 000420
- Practice address
- 108 Cherry Street Suite 1
St Johnsburg, VT 05819 - Phone
- (802) 748-8842
- Fax
- (802) 748-9014
- NPI assigned
- Apr 29, 2008
- Last updated
- Apr 29, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 000420 | VT | Primary |
Addresses
Primary practice location
108 Cherry Street Suite 1
St Johnsburg, VT 05819
Mailing address
108 Cherry Street Suite 1
St Johnsburg, VT 05819
Phone (802) 748-8842
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000420 | VT | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209427200000",
"number": "1548435696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 CHERRY STREET SUITE 1",
"city": "ST JOHNSBURG",
"state": "VT",
"postal_code": "05819",
"telephone_number": "802-748-8842",
"fax_number": "802-748-9014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 CHERRY STREET SUITE 1",
"city": "ST JOHNSBURG",
"state": "VT",
"postal_code": "05819",
"telephone_number": "802-748-8842",
"fax_number": "802-748-9014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHTBEAR",
"first_name": "PHILIP",
"name_prefix": "Mr.",
"credential": "MA LADC CADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2008-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "VT",
"license": "000420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Johnsburg, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.