Healthcare Provider Details

I. General information

NPI: 1245532233
Provider Name (Legal Business Name): MICHELLE A TURBIDE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 REYNOLDS RD
GRAND ISLE VT
05458-2120
US

IV. Provider business mailing address

51 REYNOLDS RD
GRAND ISLE VT
05458-2120
US

V. Phone/Fax

Practice location:
  • Phone: 802-654-7607
  • Fax: 802-654-9155
Mailing address:
  • Phone: 802-372-8209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0001226
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: