Provider Demographics
NPI:1881759777
Name:ALETKIN, MICHELLE HART (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HART
Last Name:ALETKIN
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 1:457 BOWLING BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048-9032
Mailing Address - Country:US
Mailing Address - Phone:727-491-3999
Mailing Address - Fax:727-491-3999
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1356
Practice Address - Country:US
Practice Address - Phone:727-491-3999
Practice Address - Fax:727-491-3999
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL110161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid