Provider Demographics
NPI:1962731018
Name:MICHELLE RENE CONDRY
Entity type:Organization
Organization Name:MICHELLE RENE CONDRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:CONDRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-407-0257
Mailing Address - Street 1:7862 W IRLO BRONSON HWY
Mailing Address - Street 2:# 209
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1764
Mailing Address - Country:US
Mailing Address - Phone:813-407-0257
Mailing Address - Fax:
Practice Address - Street 1:7862 W IRLO BRONSON HWY
Practice Address - Street 2:# 209
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1764
Practice Address - Country:US
Practice Address - Phone:813-407-0257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8414251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health