Provider Demographics
NPI:1669643979
Name:ARMAND-TASSY, MICHAELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:
Last Name:ARMAND-TASSY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 ROANOKE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2098
Mailing Address - Country:US
Mailing Address - Phone:631-369-4418
Mailing Address - Fax:631-369-4421
Practice Address - Street 1:1380 ROANOKE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2098
Practice Address - Country:US
Practice Address - Phone:631-369-4418
Practice Address - Fax:631-369-4421
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071965-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNU3561Medicare PIN