Doctor Name: | SHANA KOTELCHUCK |
NPI Number: | 1073648895 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | 089-0001123 |
Business Practice Address: | 11 S Main St Randolph, VT - 050601330 |
Business Phone Number: | 8027284466 |
Business Fax Number: | 8027284197 |
Mailing Address: | 160 Shady Rill Rd, MIDDLESEX |
State: | VT |
Postal Code: | 056029370 |
Phone Number: | 8022232655 |
Fax Number: | |
NPI Enumeration Date: | 02/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 089-0001123 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |