Provider Demographics
NPI:1922217603
Name:LESESNE-DE SANTIS, MICHELLE KAYE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KAYE
Last Name:LESESNE-DE SANTIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9859 NW 3RD CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7079
Mailing Address - Country:US
Mailing Address - Phone:954-472-8024
Mailing Address - Fax:
Practice Address - Street 1:9859 NW 3RD CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7079
Practice Address - Country:US
Practice Address - Phone:954-472-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7550OtherLCSW