Individual provider · Type 1 NPI

Shana Kotelchuck, LICSW

Clinical Social Worker · Randolph, VT

NPI number 1073648895 Active

Practice location

11 S Main St
Randolph, VT 05060-1330

Call (802) 728-4466 Map

Fax (802) 728-4197

Mailing address

160 Shady Rill Rd
Middlesex, VT 05602-9370

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700X089-0001123 (VT)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1073648895

Shana Kotelchuck, LICSW's National Provider Identifier is 1073648895, issued on Feb 22, 2007. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Randolph, VT. The record was last updated on Jul 8, 2007.