Provider Demographics
NPI:1326835091
Name:WISNIEWSKI, MICHELLE ROSE (MSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ROSE
Last Name:WISNIEWSKI
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:GRISWOLD
Mailing Address - State:CT
Mailing Address - Zip Code:06351-1537
Mailing Address - Country:US
Mailing Address - Phone:860-608-3210
Mailing Address - Fax:
Practice Address - Street 1:934 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-1405
Practice Address - Country:US
Practice Address - Phone:860-779-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker