Provider Demographics
NPI:1902380199
Name:BAETA, MICHELE CATHERINE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:CATHERINE
Last Name:BAETA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1232
Mailing Address - Country:US
Mailing Address - Phone:508-285-0148
Mailing Address - Fax:508-285-0155
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-1232
Practice Address - Country:US
Practice Address - Phone:508-285-0148
Practice Address - Fax:508-285-0155
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117587-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical