Provider Demographics
NPI:1790266864
Name:MICHEL, BERNICE JOAN (MSW)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:JOAN
Last Name:MICHEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1661
Mailing Address - Country:US
Mailing Address - Phone:508-498-1252
Mailing Address - Fax:
Practice Address - Street 1:20 WATERVIEW DR
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1661
Practice Address - Country:US
Practice Address - Phone:508-498-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA112147222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist