Provider Demographics
NPI:1669830139
Name:WIDDOWS, MICHELLE DARA (PMHNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DARA
Last Name:WIDDOWS
Suffix:
Gender:F
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KAPLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:78 GAY BOWER ROAD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468
Mailing Address - Country:US
Mailing Address - Phone:718-873-5477
Mailing Address - Fax:718-979-6940
Practice Address - Street 1:78 GAY BOWER ROAD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468
Practice Address - Country:US
Practice Address - Phone:718-873-5477
Practice Address - Fax:718-979-6940
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606396163W00000X, 163WC3500X
CT10.146391163WC3500X
CT12.014410363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation