Provider Demographics
NPI:1154770220
Name:MICHAELSON, CHLOE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:MICHAELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 YELLOWSTONE BLVD
Mailing Address - Street 2:APARTMENT B67
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3417
Mailing Address - Country:US
Mailing Address - Phone:516-521-1249
Mailing Address - Fax:
Practice Address - Street 1:6838 YELLOWSTONE BLVD
Practice Address - Street 2:APARTMENT B67
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3417
Practice Address - Country:US
Practice Address - Phone:516-521-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097731104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker