Provider Demographics
NPI:1295983385
Name:VAUGHAN, MICHELLE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2316
Mailing Address - Country:US
Mailing Address - Phone:207-467-0233
Mailing Address - Fax:
Practice Address - Street 1:160 WALDEN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3622
Practice Address - Country:US
Practice Address - Phone:978-369-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1160191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical