Provider Demographics
NPI:1992413843
Name:MARTHA MICHAUD
Entity type:Organization
Organization Name:MARTHA MICHAUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-498-8403
Mailing Address - Street 1:881 SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1440
Mailing Address - Country:US
Mailing Address - Phone:860-929-0061
Mailing Address - Fax:
Practice Address - Street 1:881 SWAMP RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1440
Practice Address - Country:US
Practice Address - Phone:860-929-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty