Provider Demographics
NPI:1326668054
Name:LAKE, MICHAEL MORRIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MORRIS
Last Name:LAKE
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 1:70 BROOKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3139
Mailing Address - Country:US
Mailing Address - Phone:201-400-7354
Mailing Address - Fax:
Practice Address - Street 1:70 BROOKLAWN DR
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-3139
Practice Address - Country:US
Practice Address - Phone:201-400-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058723001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical