Provider Demographics
NPI:1447223797
Name:PIACQUADIO, MICHELLE ANTOINETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:PIACQUADIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANTOINETTE
Other - Last Name:FORD - FINCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3409 WHITE FIR CT UNIT D
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3609
Mailing Address - Country:US
Mailing Address - Phone:757-581-7639
Mailing Address - Fax:
Practice Address - Street 1:1050 W PERIMETER RD
Practice Address - Street 2:JOINT BASE ANDREWS AFB
Practice Address - City:ANDREWS AIR FORCE BASE
Practice Address - State:MD
Practice Address - Zip Code:20762-6601
Practice Address - Country:US
Practice Address - Phone:240-857-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040011911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01884OtherMCARE GROUP
253774OtherANTHEM PPO BCBS
066469OtherMAGELLAN
018485OtherVALUE OPTIONS
084060OtherSENTARA OPTIMA
VA008917612Medicaid
17011OtherCIGNA
P00035376OtherMCARE RAILROAD
241248OtherMANAGED HEALTH NETWORK
241248OtherMANAGED HEALTH NETWORK
VA800002338Medicare ID - Type Unspecified