Provider Demographics
NPI:1063832616
Name:PLATT, MICHAEL (LSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PLATT
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7903
Mailing Address - Country:US
Mailing Address - Phone:610-351-3477
Mailing Address - Fax:610-351-3488
Practice Address - Street 1:1125 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7903
Practice Address - Country:US
Practice Address - Phone:610-351-3477
Practice Address - Fax:610-351-3488
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker