Shana Kotelchuck, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089-0001123 Issued in VT

Practice address

11 S Main St
Randolph, VT 05060-1330

Phone

(802) 728-4466

Fax

(802) 728-4197

NPI assigned

Feb 22, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073648895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 SHADY RILL RD",
            "city": "MIDDLESEX",
            "state": "VT",
            "postal_code": "056029370",
            "telephone_number": "802-223-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S MAIN ST",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050601330",
            "telephone_number": "802-728-4466",
            "fax_number": "802-728-4197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTELCHUCK",
        "first_name": "SHANA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089-0001123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013367",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles King, BS
• Danielle King, M.ED.
• Elissa Klingensmith, BS
• Jon-Richard Knoff, M.D.
• Erica Koch, ND
• KPH Healthcare Services, Inc. (Kinney Drugs #102)
• Kelly Kramer
• Lorraine Anne Kramer, M.ED., L.A.D.C.
• Hallie Lambert, BA
• Andrea L. Larosa, FNP

• Clinical Social Worker in Randolph, VT
• Providers in Randolph, VT by specialty
• Clinical Social Worker in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.