Provider Demographics
NPI:1093906885
Name:MICHELLI, ROGER (BA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MICHELLI
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-3432
Mailing Address - Country:US
Mailing Address - Phone:707-464-4349
Mailing Address - Fax:707-464-4572
Practice Address - Street 1:370 9TH ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3432
Practice Address - Country:US
Practice Address - Phone:707-464-4349
Practice Address - Fax:707-464-4572
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker