Provider Demographics
NPI:1598285827
Name:WORONOWSKI, MICHELLE ATLEE DAVIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ATLEE DAVIS
Last Name:WORONOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 COWING ST
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-3522
Mailing Address - Country:US
Mailing Address - Phone:814-596-2804
Mailing Address - Fax:
Practice Address - Street 1:5130 E MAIN STREET RD STE 2
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3444
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0911921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical