Provider Demographics
NPI:1730433061
Name:MICHAUD, KIMBERLY ELLEN (LCAT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57 WILLOUGHBY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5257
Mailing Address - Country:US
Mailing Address - Phone:347-473-7446
Mailing Address - Fax:718-222-1736
Practice Address - Street 1:320 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1200
Practice Address - Country:US
Practice Address - Phone:212-645-8111
Practice Address - Fax:212-229-2178
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001439221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001439OtherLICENSE