Provider Demographics
NPI:1316961311
Name:MICHAUD, THERESA GERARD (LCSW)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:GERARD
Last Name:MICHAUD
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 1:3 SHEFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2015
Mailing Address - Country:US
Mailing Address - Phone:732-332-1086
Mailing Address - Fax:732-332-1086
Practice Address - Street 1:3 SHEFFIELD CT
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2015
Practice Address - Country:US
Practice Address - Phone:732-332-1086
Practice Address - Fax:732-332-1086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000883001041C0700X
NJ37F100128000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640895Medicare ID - Type Unspecified