Healthcare Provider Details

I. General information

NPI: 1477417764
Provider Name (Legal Business Name): AMANDA ROSE MICHAUD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 COVENTRY ST
HARTFORD CT
06112-1524
US

IV. Provider business mailing address

46 COVENTRY ST
HARTFORD CT
06112-1524
US

V. Phone/Fax

Practice location:
  • Phone: 860-569-5900
  • Fax: 860-569-5900
Mailing address:
  • Phone: 860-569-5900
  • Fax: 860-569-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10422
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: