Provider Demographics
NPI:1063054252
Name:DR. MICHELLE ALBANO LLC
Entity type:Organization
Organization Name:DR. MICHELLE ALBANO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SCHULTZ
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-465-6038
Mailing Address - Street 1:2390 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1812
Mailing Address - Country:US
Mailing Address - Phone:954-465-6038
Mailing Address - Fax:
Practice Address - Street 1:7820 PETERS RD STE E100
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4019
Practice Address - Country:US
Practice Address - Phone:954-577-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)