Provider Demographics
NPI:1316134240
Name:FLETCHER, MICHELE (LCSW-R, CASAC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TIOGA BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4150
Mailing Address - Country:US
Mailing Address - Phone:607-785-4156
Mailing Address - Fax:607-625-4438
Practice Address - Street 1:3 TIOGA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-4150
Practice Address - Country:US
Practice Address - Phone:607-785-4156
Practice Address - Fax:607-625-4438
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11577101YA0400X
NYR049819-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)