Provider Demographics
NPI:1083982862
Name:MOHNER, MICHELLE A (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:MOHNER
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 1:13007 INDIGO WAY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4113
Mailing Address - Country:US
Mailing Address - Phone:440-554-4753
Mailing Address - Fax:
Practice Address - Street 1:13007 INDIGO WAY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4113
Practice Address - Country:US
Practice Address - Phone:440-554-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL177911041C0700X
OHI.24056761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083982862Medicaid