Provider Demographics
NPI:1801038278
Name:DESIMONE, MICHELLE ANGELEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANGELEE
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 CADMAN PLZ W FL 12
Mailing Address - Street 2:1 PIERREPONT PLAZA
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2701
Mailing Address - Country:US
Mailing Address - Phone:917-364-9983
Mailing Address - Fax:
Practice Address - Street 1:300 CADMAN PLZ W FL 12
Practice Address - Street 2:1 PIERREPONT PLAZA
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2701
Practice Address - Country:US
Practice Address - Phone:917-364-9983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0788731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400137289Medicare PIN