Provider Demographics
NPI:1649361460
Name:MCCABE, MICHELE P (CSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:P
Last Name:MCCABE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:MICKEY
Other - Middle Name:P
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2558
Mailing Address - Country:US
Mailing Address - Phone:607-763-8008
Mailing Address - Fax:607-763-8019
Practice Address - Street 1:507 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1810
Practice Address - Country:US
Practice Address - Phone:607-763-8008
Practice Address - Fax:607-763-8019
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00058991041C0700X
NYR0589911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02195206Medicaid
NY02195206Medicaid
S75813Medicare UPIN