Provider Demographics
NPI:1477954246
Name:MICHELLE PELKEY, LICSW
Entity Type:Organization
Organization Name:MICHELLE PELKEY, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PELKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-309-2126
Mailing Address - Street 1:664 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-8890
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00998171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty