Healthcare Provider Details

I. General information

NPI: 1801806195
Provider Name (Legal Business Name): JANET L MICKLE MS RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH STREET DEPT OF PSYCHIATRY PCOT
PITTSFIELD MA
01201
US

IV. Provider business mailing address

725 NORTH STREET DEPT OF PSYCHIATRY PCOT
PITTSFIELD MA
01201
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2000
  • Fax: 413-447-2176
Mailing address:
  • Phone: 413-447-2000
  • Fax: 413-447-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number174015
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: