Individual
DR. DIANA MICHALCZUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
357 SHIELDS DR, BENNINGTON, VT 05201-9810
(802) 447-1409
(802) 442-5199
Mailing address
357 SHIELDS DR, BENNINGTON, VT 05201-9810
(802) 447-1409
(802) 442-5199
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
048.0086156
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003006801
MEDICARE PTAN
VT
01
—
P01173650
RAILROAD MEDICARE
VT
Enumeration date
09/15/2008
Last updated
06/28/2013
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