Provider Demographics
NPI:1265445373
Name:WARD, MICHELLE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E MAIN ST UNIT A6
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3130
Mailing Address - Country:US
Mailing Address - Phone:203-483-6351
Mailing Address - Fax:
Practice Address - Street 1:211 E MAIN ST UNIT A6
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3130
Practice Address - Country:US
Practice Address - Phone:203-483-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11403115OtherC.A.Q.H.