Healthcare Provider Details

I. General information

NPI: 1306623624
Provider Name (Legal Business Name): HOPE MICHELE EVELYN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TOWER LN STE 100
AVON CT
06001-4212
US

IV. Provider business mailing address

20 TOWER LN STE 100
AVON CT
06001-4212
US

V. Phone/Fax

Practice location:
  • Phone: 860-382-0096
  • Fax:
Mailing address:
  • Phone: 860-382-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number013737
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: