Provider Demographics
NPI:1053086108
Name:SUMMERS, MICHELE T (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:T
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2315
Mailing Address - Country:US
Mailing Address - Phone:516-922-6867
Mailing Address - Fax:
Practice Address - Street 1:12 IRVING PL
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2315
Practice Address - Country:US
Practice Address - Phone:516-922-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health