Provider Demographics
NPI:1215016332
Name:CHENEVERT, MICHELE (LMFT LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:CHENEVERT
Suffix:
Gender:F
Credentials:LMFT LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W TOWN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2112
Mailing Address - Country:US
Mailing Address - Phone:860-886-1508
Mailing Address - Fax:860-889-4606
Practice Address - Street 1:200 W TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2112
Practice Address - Country:US
Practice Address - Phone:860-886-1508
Practice Address - Fax:860-889-4606
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000789106H00000X
CT0068461041C0700X
ME119911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical