Provider Demographics
NPI:1639220494
Name:MICHAUD, RONALD LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LOUIS
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PROSPECTOR RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3046
Mailing Address - Country:US
Mailing Address - Phone:978-667-8977
Mailing Address - Fax:978-667-1238
Practice Address - Street 1:1 PROSPECTOR RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3046
Practice Address - Country:US
Practice Address - Phone:978-667-8977
Practice Address - Fax:978-667-1238
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH466103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TM1800X
MA4330103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04309OtherMASSBLUE CROSS
NH30004009Medicaid