Provider Demographics
NPI:1265649057
Name:SCULL, MICHELLE MARA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARA
Last Name:SCULL
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 1:3 THEISE TER
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2827
Mailing Address - Country:US
Mailing Address - Phone:845-213-9754
Mailing Address - Fax:
Practice Address - Street 1:27 PARK PL
Practice Address - Street 2:APARTMENT #6
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3549
Practice Address - Country:US
Practice Address - Phone:914-419-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082992-11041C0700X
NJ44SC052557001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical