Provider Demographics
NPI:1922520592
Name:MICHEL, SAMSON (BA)
Entity Type:Individual
Prefix:
First Name:SAMSON
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WASHINGTON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4764
Mailing Address - Country:US
Mailing Address - Phone:617-438-3483
Mailing Address - Fax:781-817-6745
Practice Address - Street 1:400 WASHINGTON ST. SUITE 106
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:617-438-3483
Practice Address - Fax:781-817-6745
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health