Provider Demographics
NPI:1508996968
Name:J MICHEL ASSOCIATE
Entity Type:Organization
Organization Name:J MICHEL ASSOCIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:315-859-1470
Mailing Address - Street 1:36 KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1523
Mailing Address - Country:US
Mailing Address - Phone:315-859-1470
Mailing Address - Fax:315-859-1480
Practice Address - Street 1:36 KELLOGG ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1523
Practice Address - Country:US
Practice Address - Phone:315-859-1470
Practice Address - Fax:315-859-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037032104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1307OtherBCBS
56219AMedicare ID - Type Unspecified