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NPI Code Detail

MEDICARE: MR. MICHAEL A ETHERIDGE LMSW

MEDICARE: MR. MICHAEL A ETHERIDGE LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker062637NY

General Provider Information

NPI Number : 1376924225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL A ETHERIDGE LMSW
Provider Business Mailing Address
First Line : 165 CHRISTOPHER ST
Second Line : APT 2BB
City : NEW YORK
State : NY
Zip : 10014-2803
Country : US
Telephone Number : 646-408-7382
Fax Number :
Provider Business Practice Location Address
First Line : 81 WORTH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10013-3411
Country : US
Telephone Number : 646-408-7382
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2015
Last Update Date : 06/17/2015

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