Provider Demographics
NPI:1134890395
Name:SPIES, MICHELLE J
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:SPIES
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 1:77 TYNEMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3115
Mailing Address - Country:US
Mailing Address - Phone:908-370-1008
Mailing Address - Fax:
Practice Address - Street 1:77 TYNEMOUTH CT
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-3115
Practice Address - Country:US
Practice Address - Phone:908-370-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058312001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical