Provider Demographics
NPI:1790963262
Name:BORGET-DE VOS, MICHELE MARIE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE
Last Name:BORGET-DE VOS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4770 SUNRISE HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2911
Mailing Address - Country:US
Mailing Address - Phone:516-643-2169
Mailing Address - Fax:516-804-9603
Practice Address - Street 1:4770 SUNRISE HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2911
Practice Address - Country:US
Practice Address - Phone:516-643-2169
Practice Address - Fax:516-804-9603
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR072327-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12360799OtherCAQH