Provider Demographics
NPI:1063846681
Name:CONDON, MICAELA MORRIS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICAELA
Middle Name:MORRIS
Last Name:CONDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2106
Mailing Address - Country:US
Mailing Address - Phone:508-679-0033
Mailing Address - Fax:
Practice Address - Street 1:179 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2106
Practice Address - Country:US
Practice Address - Phone:508-679-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW016061041C0700X
RIISW025911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical