Provider Demographics
NPI:1366690695
Name:JARVIS, MICHELLE ALAYNE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ALAYNE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CRAFTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-4403
Mailing Address - Country:US
Mailing Address - Phone:412-491-5875
Mailing Address - Fax:
Practice Address - Street 1:3117 WASHINGTON PIKE
Practice Address - Street 2:FREEDOM HEALTHCARE SERVICES
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15017
Practice Address - Country:US
Practice Address - Phone:412-722-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1231741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical