Provider Demographics
NPI:1083722870
Name:MICHELSON-PRINCE, LONNI RUTH (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LONNI
Middle Name:RUTH
Last Name:MICHELSON-PRINCE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SOUTH 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-354-4558
Mailing Address - Fax:718-830-9088
Practice Address - Street 1:98-120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ILEGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-830-0246
Practice Address - Fax:718-830-9088
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0665591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3598363OtherOXFORD
0256FHMedicare ID - Type Unspecified
P3598363OtherOXFORD