SHANA KOTELCHUCK (NPI# 1073648895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073648895 |
| Entity Type | Individual |
| Full Name | SHANA KOTELCHUCK |
| Credential | LICSW |
| Practice Address |
11 S Main St Randolph VT 05060-1330 |
| Mailing Address |
160 Shady Rill Rd Middlesex VT 05602-9370 |
| Practice Telephone | 8027284466 |
| Practice Fax Number | 8027284197 |
| Mailing Telephone | 8022232655 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
089-0001123 | VT | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VT | 1013367 | 05 |
| Street Address |
11 S MAIN ST |
| City | RANDOLPH |
| State | VT |
| Zip Code | 05060-1330 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982896445 | Elizabeth Macaulay | Counselor | 11 S Main St, P.o. Box G, Randolph, VT 05060-1126 | 2007-08-17 |
| 1255544821 | Annie Luke | Counselor | 11 S Main St, Randolph, VT 05060-1330 | 2007-05-08 |
| 1225150568 | Alida Shriber | Social Worker | 11 S Main St, Randolph, VT 05060-1330 | 2007-04-06 |
| 1114062213 | Kerrie Taylor | Counselor | 11 S Main St, Randolph, VT 05060-1330 | 2007-02-20 |
| 1831239680 | Linda Chambers | Counselor | 11 S Main St, Randolph, VT 05060-1330 | 2007-02-08 |
| 1902944846 | Clara Martin Center | Clinic/Center | 11 S Main St, Randolph, VT 05060-1330 | 2007-02-02 |
| 1265570113 | Clara Martin Center | Clinic/Center | 11 S Main St, Randolph, VT 05060-1330 | 2007-02-02 |
| 1356489207 | Clara Martin Center | Clinic/Center | 11 S Main St, Randolph, VT 05060-1330 | 2007-02-02 |
| 1437201423 | Tammy Austin | Marriage & Family Therapist | 11 S Main St, Randolph, VT 05060-1330 | 2007-01-18 |
| 1366592776 | Ruth Kibby | Counselor | 11 S Main St, Randolph, VT 05060-1330 | 2007-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497003099 | Courtney Austin | Pharmacist | 12 North Main St., Randolph, VT 05060 | 2012-08-29 |
| 1851467658 | John Leonard Westbrook | Dentist | 1422 Vt Rt 66, Randolph, VT 05060 | 2006-11-27 |
| 1750470829 | Christopher Mclean Wilson | Dentist | 55 Central Street, Randolph, VT 05060 | 2006-10-12 |
| 1538170006 | Eric C Medved | Physical Therapist | 44 South Main Street, Randolph, VT 05060 | 2006-08-10 |
| 1295100048 | Ashley Shepard | Counselor | 11 N Main St, Randolph, VT 05060 | 2015-12-04 |
| 1326434713 | Emilija O Florance | Family Medicine | 44 S Main St, Randolph, VT 05060 | 2015-04-13 |
| 1891117545 | Penny Fossman | Registered Nurse | 44 S Main St, Randolph, VT 05060 | 2014-01-15 |
| 1053679266 | Clara Martin Center | Community/Behavioral Health | 11 Main Street, Randolph, VT 05060 | 2012-04-25 |
| 1770840829 | Andrea L. Larosa | Nurse Practitioner | 44 South Main Street, Box 2000, Randolph, VT 05060 | 2012-04-13 |
| 1043498561 | Jessica Schupp | Counselor | 11 Main Street, Randolph, VT 05060 | 2008-02-06 |
| Find all providers in zip 05060 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154932879 | Pcs Tele-behavioral Health Services LLC | Social Worker | 7 Van Tassel Dr, Randolph, MA 02368-2819 | 2020-08-14 |
| 1932761632 | Carly H Herschman | Social Worker | 2 W Hanover Ave Ste 203, Randolph, NJ 07869-4222 | 2019-07-02 |
| 1255995049 | Daniel Joseph Bellistri | Social Worker | Daniel Bellistri, 70 Memorial Pkwy., Randolph, MA 02368 | 2019-04-26 |
| 1073079943 | Elaine M. Gatewood | Social Worker | 1201 Irving Rd, Randolph, MA 02368-1800 | 2019-02-15 |
| 1780150102 | Rita Bouchedid | Social Worker | 46 Center Grove Rd Apt U102, Randolph, NJ 07869-4439 | 2018-10-24 |
| 1841775376 | Vivian Soper | Social Worker | 34 Sarah St, Randolph, MA 02368-1908 | 2018-10-01 |
| 1023592375 | Carolyn Ruth Sheppard | Social Worker | 35 Mcdevitt Rd, Randolph, MA 02368-3850 | 2018-09-23 |
| 1346722832 | Peter Angelos | Social Worker | 33 Fitch Ter, Randolph, MA 02368-5121 | 2018-08-31 |
| 1184103830 | Anthony Bosco | Social Worker | 123 Reed St, Randolph, MA 02368-1621 | 2018-08-13 |
| 1326554064 | Misty Pisani | Social Worker | 47 Collins Ave, Randolph, MA 02368-2003 | 2017-12-18 |
| Find all providers in RANDOLPH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.