Provider Demographics
NPI:1629319637
Name:LIBBY, MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LIBBY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVIS SQUARE
Mailing Address - Street 2:BASEMENT LEVEL
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-623-6111
Mailing Address - Fax:617-776-7165
Practice Address - Street 1:1 DAVIS SQ
Practice Address - Street 2:BASEMENT LEVEL
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2904
Practice Address - Country:US
Practice Address - Phone:617-623-6111
Practice Address - Fax:617-776-7165
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator