Healthcare Provider Details

I. General information

NPI: 1790846145
Provider Name (Legal Business Name): MICHELLE L BYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 SW FEDERAL HWY
STUART FL
34994-2962
US

IV. Provider business mailing address

PO BOX 523
JENSEN BEACH FL
34958
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-8826
  • Fax: 772-283-5531
Mailing address:
  • Phone: 772-286-8826
  • Fax: 772-283-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: