Provider Demographics
NPI:1427111426
Name:MCCLOSKEY, MICHELLE MARIE (MED)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3623 E GOLDFINCH GATE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4517
Mailing Address - Country:US
Mailing Address - Phone:602-488-1294
Mailing Address - Fax:480-704-2657
Practice Address - Street 1:3623 E GOLDFINCH GATE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4517
Practice Address - Country:US
Practice Address - Phone:602-488-1294
Practice Address - Fax:480-704-2657
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker