Provider Demographics
NPI:1235433897
Name:MICHEL, JAQUELINE G
Entity Type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:G
Last Name:MICHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JAQUELINE
Other - Middle Name:G
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWR
Mailing Address - Street 1:1 KIRKLAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1426
Mailing Address - Country:US
Mailing Address - Phone:315-859-1470
Mailing Address - Fax:315-853-3242
Practice Address - Street 1:1 KIRKLAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1426
Practice Address - Country:US
Practice Address - Phone:315-859-1470
Practice Address - Fax:315-853-3242
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037032-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical