Provider Demographics
NPI:1437939675
Name:PRINCE, MICHAEL (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PRINCE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 N LAKEWOOD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3202
Mailing Address - Country:US
Mailing Address - Phone:917-710-0633
Mailing Address - Fax:
Practice Address - Street 1:3232 N LAKEWOOD AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3202
Practice Address - Country:US
Practice Address - Phone:917-710-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111266-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical