Provider Demographics
NPI:1194893735
Name:VICHOT, MICHELLE PEREZ (MSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PEREZ
Last Name:VICHOT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CLYDESDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1157
Mailing Address - Country:US
Mailing Address - Phone:617-884-9435
Mailing Address - Fax:617-889-5190
Practice Address - Street 1:265 BEACH ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3131
Practice Address - Country:US
Practice Address - Phone:617-912-7704
Practice Address - Fax:781-286-5636
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical