Provider Demographics
NPI:1225403975
Name:PELKEY, MICHELLE D (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:PELKEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1551
Mailing Address - Country:US
Mailing Address - Phone:802-309-2126
Mailing Address - Fax:
Practice Address - Street 1:132 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1551
Practice Address - Country:US
Practice Address - Phone:802-309-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00998171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical