Provider Demographics
NPI:1710183223
Name:SALLEY, MICHELE MARIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:MARIE
Last Name:SALLEY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 HEMPSTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2115
Mailing Address - Country:US
Mailing Address - Phone:516-426-2919
Mailing Address - Fax:
Practice Address - Street 1:55 HORIZON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4436
Practice Address - Country:US
Practice Address - Phone:631-691-8000
Practice Address - Fax:631-920-8165
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0571601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400031882Medicare PIN