Provider Demographics
NPI:1306051586
Name:DITCHFIELD, MICHAEL (MSW,LICSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:DITCHFIELD
Suffix:
Gender:M
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 354
Mailing Address - Street 2:76 CHASE RD
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-9729
Mailing Address - Country:US
Mailing Address - Phone:508-627-7348
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 354
Practice Address - Street 2:76 CHASE RD
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-9729
Practice Address - Country:US
Practice Address - Phone:508-627-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10245441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06989Medicare ID - Type Unspecified