Provider Demographics
NPI:1427096338
Name:KLEMCHUK, HELEN (PHD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:KLEMCHUK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1716
Mailing Address - Country:US
Mailing Address - Phone:802-524-9727
Mailing Address - Fax:
Practice Address - Street 1:75 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1716
Practice Address - Country:US
Practice Address - Phone:802-524-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000692103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1577Medicaid
VT0VN1577Medicaid