Provider Demographics
NPI:1891460911
Name:HERVIEUX, MICHELLE MACKIE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MACKIE
Last Name:HERVIEUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 PONTIAC AVE APT 18301
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5900
Mailing Address - Country:US
Mailing Address - Phone:401-533-3409
Mailing Address - Fax:
Practice Address - Street 1:1992 OLD LOUISQUISSET PIKE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4590
Practice Address - Country:US
Practice Address - Phone:401-475-0653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW0254104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker