Provider Demographics
NPI:1689991143
Name:SOODEK, MICHELLE D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:SOODEK
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 1:896 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4603
Mailing Address - Country:US
Mailing Address - Phone:516-564-5726
Mailing Address - Fax:
Practice Address - Street 1:896 DURHAM RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4603
Practice Address - Country:US
Practice Address - Phone:516-578-4145
Practice Address - Fax:516-578-4145
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080856-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical