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NPI Code Detail

MEDICARE: MRS. MICHELLE LYNN TIGHE LCSW

MEDICARE: MRS. MICHELLE LYNN TIGHE LCSW
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
1104100000XSocial Worker065505-1NY
21041C0700XClinical Social Worker091131NY

General Provider Information

NPI Number : 1912141102
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LYNN TIGHE LCSW
Provider Business Mailing Address
First Line : 29 MAYFLOWER LN
Second Line :
City : EAST SETAUKET
State : NY
Zip : 11733-3303
Country : US
Telephone Number : 631-474-4046
Fax Number :
Provider Business Practice Location Address
First Line : 1235 MONTAUK HWY
Second Line :
City : MASTIC
State : NY
Zip : 11950-2917
Country : US
Telephone Number : 631-591-0396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2009
Last Update Date : 03/23/2021

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