Provider Demographics
NPI:1487274817
Name:PRICE, MICHAEL L (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:PRICE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 N FEDERAL HWY APT 215
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6556
Mailing Address - Country:US
Mailing Address - Phone:954-663-7657
Mailing Address - Fax:
Practice Address - Street 1:505 S FEDERAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4147
Practice Address - Country:US
Practice Address - Phone:833-822-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW170471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty