Provider Demographics
NPI:1891002218
Name:CIAK, MICHELLE ANNE (LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:CIAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 NEWFIELD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1883
Mailing Address - Country:US
Mailing Address - Phone:860-740-7191
Mailing Address - Fax:860-740-6132
Practice Address - Street 1:954 NEWFIELD ST FL 2
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1883
Practice Address - Country:US
Practice Address - Phone:860-740-7191
Practice Address - Fax:860-740-6132
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist