Provider Demographics
NPI:1720785314
Name:ANDRADE, MICHAEL M (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HARTFORD AVE E
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1126
Mailing Address - Country:US
Mailing Address - Phone:401-617-6998
Mailing Address - Fax:
Practice Address - Street 1:25 THURBER BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1816
Practice Address - Country:US
Practice Address - Phone:401-233-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW037591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical