Provider Demographics
NPI:1740026343
Name:PRICE, MICHELE BRIDGETT (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:BRIDGETT
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SKYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1817
Mailing Address - Country:US
Mailing Address - Phone:631-807-9619
Mailing Address - Fax:
Practice Address - Street 1:365 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3027
Practice Address - Country:US
Practice Address - Phone:631-807-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012751-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical