Provider Demographics
NPI:1134315724
Name:CONDRY, MICHELLE R (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:CONDRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5141
Mailing Address - Country:US
Mailing Address - Phone:352-793-5900
Mailing Address - Fax:352-793-8050
Practice Address - Street 1:1389 S US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:SUMTERVILLE
Practice Address - State:FL
Practice Address - Zip Code:33585-5143
Practice Address - Country:US
Practice Address - Phone:352-793-5900
Practice Address - Fax:352-793-9558
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW84141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical