Provider Demographics
NPI:1528044088
Name:CHECKOFF, MICHAEL (EDD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:CHECKOFF
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-0127
Mailing Address - Country:US
Mailing Address - Phone:802-496-5299
Mailing Address - Fax:802-876-1101
Practice Address - Street 1:6971 RT 100
Practice Address - Street 2:VALLEY PROFESSIONAL CENTER
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673
Practice Address - Country:US
Practice Address - Phone:802-496-5299
Practice Address - Fax:802-876-1101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008175Medicaid
VT1008175Medicaid