Provider Demographics
NPI:1134457195
Name:ROOVER, MICHELLE L (LICSW, MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:ROOVER
Suffix:
Gender:F
Credentials:LICSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1910
Mailing Address - Country:US
Mailing Address - Phone:617-796-9142
Mailing Address - Fax:
Practice Address - Street 1:26 BYRD AVE
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1626
Practice Address - Country:US
Practice Address - Phone:617-796-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1171731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical