Provider Demographics
NPI:1801806195
Name:MICKLE, JANET L (MS RNCS)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:MICKLE
Suffix:
Gender:F
Credentials:MS RNCS
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:725 NORTH STREET
Mailing Address - Street 2:DEPT OF PSYCHIATRY PCOT
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2000
Mailing Address - Fax:413-447-2176
Practice Address - Street 1:725 NORTH STREET
Practice Address - Street 2:DEPT OF PSYCHIATRY PCOT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:413-447-2176
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA174015364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SA7535Medicare UPIN