1659536936 NPI number — MRS. MICHELLE GOMES FERREIRA-MACHADO M.S.W.

Table of content: MRS. MICHELLE GOMES FERREIRA-MACHADO M.S.W. (NPI 1659536936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659536936 NPI number — MRS. MICHELLE GOMES FERREIRA-MACHADO M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERREIRA-MACHADO
Provider First Name:
MICHELLE
Provider Middle Name:
GOMES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659536936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 MURRAY ST.
Provider Second Line Business Mailing Address:
FAMILY SERVICES OF GREATER WATEBURY
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-756-8317
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 MURRAY ST.
Provider Second Line Business Practice Location Address:
FAMILY SERVICES OF GREATER WATEBURY
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-756-8317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004068284 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".