Provider Demographics
NPI:1467766618
Name:PARKER, MICHAEL ROBERT (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:PARKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 DENNISTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1457
Mailing Address - Country:US
Mailing Address - Phone:503-775-1085
Mailing Address - Fax:
Practice Address - Street 1:5840 ELLSWORTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1727
Practice Address - Country:US
Practice Address - Phone:412-775-1085
Practice Address - Fax:412-744-3079
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0179301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical