Provider Demographics
NPI:1285964601
Name:PARADIS, MICHELLE S (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:PARADIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6433
Mailing Address - Country:US
Mailing Address - Phone:207-947-0366
Mailing Address - Fax:207-942-4350
Practice Address - Street 1:42 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6433
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:207-942-4350
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC12173104100000X
MELC135981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker