Provider Demographics
NPI:1255532362
Name:MICHAELS, VIRGINIA IVERSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:IVERSON
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LOWERY LN
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-3403
Mailing Address - Country:US
Mailing Address - Phone:973-543-1135
Mailing Address - Fax:973-543-6191
Practice Address - Street 1:209 COOPER AVE
Practice Address - Street 2:SUITE 9B
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1883
Practice Address - Country:US
Practice Address - Phone:973-744-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006776001041C0700X
NJ37F100123500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist