Provider Demographics
NPI:1629854682
Name:WALDMAN, MICHELE EARL (MA, MFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:EARL
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 RED BARN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1906
Mailing Address - Country:US
Mailing Address - Phone:415-726-3494
Mailing Address - Fax:
Practice Address - Street 1:10700 RED BARN LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1906
Practice Address - Country:US
Practice Address - Phone:415-726-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94781101YM0800X
MDLCM844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health