Provider Demographics
NPI:1457559312
Name:WHEELER, MICHELE ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3201
Mailing Address - Country:US
Mailing Address - Phone:917-683-3643
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:SUITE 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4403
Practice Address - Country:US
Practice Address - Phone:917-683-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070295-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker