Provider Demographics
NPI:1053207134
Name:MICHAUD, ALEXANDRA KATHERINE (LMSW-CC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KATHERINE
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5680
Mailing Address - Country:US
Mailing Address - Phone:207-941-2952
Mailing Address - Fax:207-941-2955
Practice Address - Street 1:32 COLLEGE AVE STE 304
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6100
Practice Address - Country:US
Practice Address - Phone:207-992-0650
Practice Address - Fax:207-941-2955
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC212931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical