Provider Demographics
NPI:1245319029
Name:CLARKE, MICHELLE MARIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1744
Mailing Address - Country:US
Mailing Address - Phone:617-642-9609
Mailing Address - Fax:
Practice Address - Street 1:132 FRONT ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1386
Practice Address - Country:US
Practice Address - Phone:617-642-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical