Provider Demographics
NPI:1689739195
Name:PRATT, MICHELE (LICSW, C-ASWCM)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:LICSW, C-ASWCM
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW, C-ASWCM
Mailing Address - Street 1:74 THE FENWAY
Mailing Address - Street 2:# 17
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CAMBRIDGE HEALTH ALLIANCE
Practice Address - Street 2:1493 CAMBRIDGE ST.
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-665-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10228271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06714Medicare ID - Type UnspecifiedMEDICARE ID #