Provider Demographics
NPI:1073020871
Name:AUDET, MICHELE P (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:P
Last Name:AUDET
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FLORENCE ST APT 7
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3656
Mailing Address - Country:US
Mailing Address - Phone:617-839-8539
Mailing Address - Fax:
Practice Address - Street 1:17 FLORENCE ST APT 7
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3656
Practice Address - Country:US
Practice Address - Phone:617-839-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10202041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical