Provider Demographics
NPI:1194762609
Name:FUNAIOLI, MICHELLE M (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:FUNAIOLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44 PERRY ST
Mailing Address - Street 2:APT# B1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-7304
Mailing Address - Country:US
Mailing Address - Phone:212-677-6081
Mailing Address - Fax:646-602-9369
Practice Address - Street 1:197 E BROADWAY
Practice Address - Street 2:SUITE U-5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5507
Practice Address - Country:US
Practice Address - Phone:212-677-6081
Practice Address - Fax:646-602-9369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071961-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245221Medicaid