Healthcare Provider Details

I. General information

NPI: 1093482630
Provider Name (Legal Business Name): MICHELLE COST SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE COST MICHELLE MYRIE

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY ST
SPRINGFIELD MA
01104-3736
US

IV. Provider business mailing address

14 LAKEVILLA AVE
SPRINGFIELD MA
01109-1404
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6661
  • Fax: 413-733-7841
Mailing address:
  • Phone: 413-221-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1142638
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: