Provider Demographics
NPI:1194263434
Name:MICHAUD, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MICHAUD
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 1:3 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3860
Mailing Address - Country:US
Mailing Address - Phone:603-752-7404
Mailing Address - Fax:603-752-5194
Practice Address - Street 1:3 12TH ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3860
Practice Address - Country:US
Practice Address - Phone:603-752-7404
Practice Address - Fax:603-752-5194
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health