Provider Demographics
NPI:1063639987
Name:MAY, MICHELE ROSS (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ROSS
Last Name:MAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5210
Mailing Address - Country:US
Mailing Address - Phone:860-888-2476
Mailing Address - Fax:866-605-3015
Practice Address - Street 1:178 E CENTER ST STE 5
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5210
Practice Address - Country:US
Practice Address - Phone:860-888-2476
Practice Address - Fax:866-605-3015
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000998106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008013904Medicaid
CT004235942Medicaid