Provider Demographics
NPI:1285175885
Name:GROVER, MICHELLE MARIA (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIA
Last Name:GROVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 CAFFERTY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-8907
Mailing Address - Country:US
Mailing Address - Phone:607-302-0107
Mailing Address - Fax:
Practice Address - Street 1:349 CAFFERTY HILL RD
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-8907
Practice Address - Country:US
Practice Address - Phone:607-302-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator