1801038278 NPI number — MRS. MICHELLE ANGELEE DESIMONE LCSW

Table of content: MRS. MICHELLE ANGELEE DESIMONE LCSW (NPI 1801038278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801038278 NPI number — MRS. MICHELLE ANGELEE DESIMONE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESIMONE
Provider First Name:
MICHELLE
Provider Middle Name:
ANGELEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1801038278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CADMAN PLZ W FL 12
Provider Second Line Business Mailing Address:
1 PIERREPONT PLAZA
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11201-2701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-364-9983
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CADMAN PLZ W FL 12
Provider Second Line Business Practice Location Address:
1 PIERREPONT PLAZA
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-364-9983
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2009

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: 1041C0700X , with the licence number:  078873 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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