Provider Demographics
NPI:1740444108
Name:LOVELL, MICHELE RENEE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MICHELE
Middle Name:RENEE
Last Name:LOVELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TRINITY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3025
Mailing Address - Country:US
Mailing Address - Phone:347-495-8196
Mailing Address - Fax:845-290-5192
Practice Address - Street 1:17 TRINITY AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3025
Practice Address - Country:US
Practice Address - Phone:347-495-8196
Practice Address - Fax:845-290-5192
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0735331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical