Provider Demographics
NPI:1609592070
Name:CONNORS, MICHELLE P
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:P
Last Name:CONNORS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:P
Other - Last Name:BOYCE-CANNARIATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, LCADC, CCS
Mailing Address - Street 1:629 RINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1408
Mailing Address - Country:US
Mailing Address - Phone:732-814-3092
Mailing Address - Fax:
Practice Address - Street 1:508 STRAIGHT ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-3044
Practice Address - Country:US
Practice Address - Phone:973-345-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00343900101YM0800X
NJ37LC00249500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health