Provider Demographics
NPI:1437817350
Name:MICHELLE LISTENS LCSW, PC
Entity Type:Organization
Organization Name:MICHELLE LISTENS LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEVANTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:516-344-7975
Mailing Address - Street 1:85 FAIRFIELD WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3426
Mailing Address - Country:US
Mailing Address - Phone:516-344-7975
Mailing Address - Fax:
Practice Address - Street 1:350 VETERANS MEMORIAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4316
Practice Address - Country:US
Practice Address - Phone:516-344-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty