Provider Demographics
NPI:1710701172
Name:BICKNELL, MICHAELA BECK (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:BECK
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:VT
Mailing Address - Zip Code:05743-2102
Mailing Address - Country:US
Mailing Address - Phone:802-349-6893
Mailing Address - Fax:
Practice Address - Street 1:1046 TEMPLE RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:VT
Practice Address - Zip Code:05743-2102
Practice Address - Country:US
Practice Address - Phone:802-349-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01358691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical