Provider Demographics
NPI:1134556517
Name:BRONZO, MICHELLE HAMILTON (LCPC, LPC, LMHC, CT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HAMILTON
Last Name:BRONZO
Suffix:
Gender:F
Credentials:LCPC, LPC, LMHC, CT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:PAULA
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8261 BUCKSPARK LN W
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4232
Mailing Address - Country:US
Mailing Address - Phone:914-806-6308
Mailing Address - Fax:
Practice Address - Street 1:8261 BUCKSPARK LN W
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4232
Practice Address - Country:US
Practice Address - Phone:914-806-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005638101YM0800X
DCPRC14859101YP2500X
VA0701006824101YP2500X
MDLC10809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional