Provider Demographics
NPI:1265914006
Name:CHMURA, MICHELE MARIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:MARIE
Last Name:CHMURA
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 1:70 BOLTWOOD WALK
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2271
Mailing Address - Country:US
Mailing Address - Phone:413-259-3038
Mailing Address - Fax:413-259-2413
Practice Address - Street 1:70 BOLTWOOD WALK
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2271
Practice Address - Country:US
Practice Address - Phone:413-259-3038
Practice Address - Fax:413-259-2413
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10206681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical