Provider Demographics
NPI:1326570706
Name:MICHAELS, JOANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MICHAELS
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 1:903 C NORTH 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016
Mailing Address - Country:US
Mailing Address - Phone:505-384-2777
Mailing Address - Fax:505-384-2204
Practice Address - Street 1:903 C NORTH 5TH ST.
Practice Address - Street 2:
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016
Practice Address - Country:US
Practice Address - Phone:505-384-2777
Practice Address - Fax:505-384-2204
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX609541041C0700X
HI43301041C0700X
NMSWB-2022-01141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical