Provider Demographics
NPI:1801452800
Name:MEDEIROS, MICHAILA (MSW)
Entity type:Individual
Prefix:
First Name:MICHAILA
Middle Name:
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1022
Mailing Address - Country:US
Mailing Address - Phone:781-718-2253
Mailing Address - Fax:
Practice Address - Street 1:11 HOLLY LN
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-1022
Practice Address - Country:US
Practice Address - Phone:781-718-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker