Provider Demographics
NPI:1952169831
Name:LACORTIGLIA, MICHELLE RENEE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:LACORTIGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FRANCIS ST # 1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4814
Mailing Address - Country:US
Mailing Address - Phone:508-423-3025
Mailing Address - Fax:
Practice Address - Street 1:75 LINDALL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2121
Practice Address - Country:US
Practice Address - Phone:978-767-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2356052163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)