Provider Demographics
NPI:1942596382
Name:MICHELS, LORI ANN
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:MICHELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 DIXWELL AVE
Mailing Address - Street 2:SUITE 305B
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3195
Mailing Address - Country:US
Mailing Address - Phone:203-676-2796
Mailing Address - Fax:
Practice Address - Street 1:2911 DIXWELL AVE
Practice Address - Street 2:SUITE 305B
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3195
Practice Address - Country:US
Practice Address - Phone:203-676-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1456106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist