Provider Demographics
NPI:1598229072
Name:BIRDWELL, MICHELLE L (BS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 WESTMINSTER ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4724
Mailing Address - Country:US
Mailing Address - Phone:978-345-0685
Mailing Address - Fax:
Practice Address - Street 1:454 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4724
Practice Address - Country:US
Practice Address - Phone:978-345-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor