Provider Demographics
NPI:1871633057
Name:DELEVANTE, MICHELLE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:DELEVANTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:170 LITTLE EAST NECK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7742
Mailing Address - Country:US
Mailing Address - Phone:631-482-8010
Mailing Address - Fax:631-482-8012
Practice Address - Street 1:170 LITTLE EAST NECK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704
Practice Address - Country:US
Practice Address - Phone:631-482-8010
Practice Address - Fax:631-482-8012
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0759601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical