Provider Demographics
NPI:1366545774
Name:MICHELI, C YVONNE (LCSWC MSW)
Entity type:Individual
Prefix:MS
First Name:C
Middle Name:YVONNE
Last Name:MICHELI
Suffix:
Gender:F
Credentials:LCSWC MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3568
Mailing Address - Street 2:65 DUKE ST, #111
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2578
Mailing Address - Country:US
Mailing Address - Phone:410-257-5750
Mailing Address - Fax:410-257-5750
Practice Address - Street 1:65 DUKE ST
Practice Address - Street 2:KAINE BLDG SUITE 111
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6128
Practice Address - Country:US
Practice Address - Phone:410-257-5750
Practice Address - Fax:410-257-5750
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD028261041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3711-0001OtherCARE FIRST BLUE CROSS
QD82OtherBLUE CROSS
5562091OtherAETNA
3242370OtherTRICARE
3242370OtherTRICARE