Provider Demographics
NPI:1952577272
Name:VINCENT, MICHELE DEGATI (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DEGATI
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3422
Mailing Address - Country:US
Mailing Address - Phone:917-496-7328
Mailing Address - Fax:
Practice Address - Street 1:63 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3422
Practice Address - Country:US
Practice Address - Phone:917-496-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730760171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical