Provider Demographics
NPI:1851368336
Name:WALDMAN, MICHELE (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465
Mailing Address - Country:US
Mailing Address - Phone:617-244-8920
Mailing Address - Fax:617-244-8921
Practice Address - Street 1:790 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5938
Practice Address - Country:US
Practice Address - Phone:781-505-8722
Practice Address - Fax:781-273-5776
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04522Medicare PIN
P04522Medicare UPIN