Provider Demographics
NPI:1144902255
Name:FAULK, MICHANYA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:MICHANYA
Middle Name:
Last Name:FAULK
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:MICHANYA
Other - Middle Name:
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LWS
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-0049
Mailing Address - Country:US
Mailing Address - Phone:800-413-8020
Mailing Address - Fax:
Practice Address - Street 1:601 RTE 37 W STE 101
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8050
Practice Address - Country:US
Practice Address - Phone:732-390-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC063463001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical