Andrea Reynolds, MA, LCMHC, LADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

068.0117987 Issued in VT

Practice address

108 Dion St
Winooski, VT 05404

Phone

(518) 221-7227

NPI assigned

Dec 19, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Andrea Palkovic Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527984000000",
    "number": "1578079166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 DION ST",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "054041517",
            "telephone_number": "518-221-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 DION ST",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "05404",
            "telephone_number": "518-221-7227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "855 Pine St",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "VT",
            "postal_code": "054014924",
            "country_code": "US",
            "telephone_number": "802-488-6300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "ANDREA",
        "credential": "MA, LCMHC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2018-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "068.0117987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "PALKOVIC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Winooski, VT
• Providers in Winooski, VT by specialty
• Mental Health Counselor in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.