Provider Demographics
NPI:1275685711
Name:BABCOCK, MICHAEL RAY (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 POMEROY LN UNIT 24
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2944
Mailing Address - Country:US
Mailing Address - Phone:413-256-8159
Mailing Address - Fax:
Practice Address - Street 1:503 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4101
Practice Address - Country:US
Practice Address - Phone:413-733-6661
Practice Address - Fax:413-733-7841
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2140751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical