Provider Demographics
NPI:1659982809
Name:TRAWCZYNSKI, MICHELE RENEE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:TRAWCZYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LONGFELLOW RD # 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2716
Mailing Address - Country:US
Mailing Address - Phone:774-239-6093
Mailing Address - Fax:
Practice Address - Street 1:324 CLARK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1214
Practice Address - Country:US
Practice Address - Phone:508-752-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health