Provider Demographics
NPI:1760136451
Name:MICHAUD, DANIELLE SARA
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SARA
Last Name:MICHAUD
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 1:75 SHARON ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3654
Mailing Address - Country:US
Mailing Address - Phone:860-593-8844
Mailing Address - Fax:
Practice Address - Street 1:75 SHARON ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3654
Practice Address - Country:US
Practice Address - Phone:860-276-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical