Provider Demographics
NPI:1083967640
Name:MICHAEL JOYCE, LICSW. PLC
Entity Type:Organization
Organization Name:MICHAEL JOYCE, LICSW. PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-264-5333
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-0392
Mailing Address - Country:US
Mailing Address - Phone:802-264-5333
Mailing Address - Fax:802-264-5338
Practice Address - Street 1:525 HERCULES DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5993
Practice Address - Country:US
Practice Address - Phone:802-264-5333
Practice Address - Fax:802-264-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900007181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021066Medicaid