Provider Demographics
NPI:1568750354
Name:BICKING, MICHELLE LOUISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:BICKING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:BYNOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:369 N GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1503
Mailing Address - Country:US
Mailing Address - Phone:860-338-6839
Mailing Address - Fax:
Practice Address - Street 1:369 N GRANBY RD
Practice Address - Street 2:
Practice Address - City:NORTH GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06060-1503
Practice Address - Country:US
Practice Address - Phone:860-338-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCBHP005945Medicaid