Healthcare Provider Details

I. General information

NPI: 1861624314
Provider Name (Legal Business Name): MICHELLE PATRICE VILLENEUVE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANNA MARSH LANE
BRATTLEBORO VT
05301-0101
US

IV. Provider business mailing address

PO BOX 101
BRATTLEBORO VT
05302-0101
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-7785
  • Fax: 802-258-3798
Mailing address:
  • Phone: 802-257-7785
  • Fax: 802-258-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0001118
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: