Provider Demographics
NPI:1740496371
Name:CHILDS, MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:CHILDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 WEST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2997
Mailing Address - Country:US
Mailing Address - Phone:413-253-0800
Mailing Address - Fax:413-253-0644
Practice Address - Street 1:441 WEST ST
Practice Address - Street 2:SUITE C
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2967
Practice Address - Country:US
Practice Address - Phone:413-253-0800
Practice Address - Fax:413-253-0644
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY 4632-PR103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool