Provider Demographics
NPI:1376127514
Name:CASTELLI, MICHAEL A (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CASTELLI
Suffix:
Gender:M
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 COURT ST STE 9
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1406
Mailing Address - Country:US
Mailing Address - Phone:802-458-8110
Mailing Address - Fax:802-458-8113
Practice Address - Street 1:79 COURT ST STE 9
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1406
Practice Address - Country:US
Practice Address - Phone:802-458-8110
Practice Address - Fax:802-458-8113
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.134327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health