Provider Demographics
NPI:1083869689
Name:LACROIX, MICHAEL BARRY (CMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BARRY
Last Name:LACROIX
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 LENOX AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4600
Mailing Address - Country:US
Mailing Address - Phone:510-435-1321
Mailing Address - Fax:
Practice Address - Street 1:340 LENOX AVE APT 1A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4600
Practice Address - Country:US
Practice Address - Phone:510-435-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24519225700000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942578202OtherMETHADONE MAINTENANCE