Provider Demographics
NPI:1316317654
Name:RAUSEO, MICHELLE LEIGH (LICSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEIGH
Last Name:RAUSEO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4011
Mailing Address - Country:US
Mailing Address - Phone:617-312-3109
Mailing Address - Fax:
Practice Address - Street 1:36 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4011
Practice Address - Country:US
Practice Address - Phone:617-312-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220884104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker