Provider Demographics
NPI:1235216649
Name:MICHAELSON, JANICE (CSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MICHAELSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W END AVE
Mailing Address - Street 2:#20T
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5601
Mailing Address - Country:US
Mailing Address - Phone:212-581-6640
Mailing Address - Fax:212-579-4678
Practice Address - Street 1:211 W 56TH ST
Practice Address - Street 2:#6M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4312
Practice Address - Country:US
Practice Address - Phone:212-581-6640
Practice Address - Fax:212-579-4678
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01225-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN94811Medicare UPIN