Provider Demographics
NPI:1013589118
Name:SUMMERS, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SUMMERS
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 1:2344 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14486-9713
Mailing Address - Country:US
Mailing Address - Phone:865-323-6006
Mailing Address - Fax:
Practice Address - Street 1:805 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2410
Practice Address - Country:US
Practice Address - Phone:585-484-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009944-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health