Provider Demographics
NPI:1790356426
Name:SHIPPOS, MICHELLE LEIGH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEIGH
Last Name:SHIPPOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LEIGH
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 N MEADOW ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4027
Mailing Address - Country:US
Mailing Address - Phone:607-862-6252
Mailing Address - Fax:844-333-0375
Practice Address - Street 1:208 N MEADOW ST UNIT 3
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4027
Practice Address - Country:US
Practice Address - Phone:607-862-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-04
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0885251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical