Healthcare Provider Details

I. General information

NPI: 1447223797
Provider Name (Legal Business Name): MICHELLE ANTOINETTE PIACQUADIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ANTOINETTE FORD - FINCH LCSW

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W PERIMETER RD JOINT BASE ANDREWS AFB
ANDREWS AIR FORCE BASE MD
20762-6601
US

IV. Provider business mailing address

3409 WHITE FIR CT UNIT D
WALDORF MD
20602-3609
US

V. Phone/Fax

Practice location:
  • Phone: 240-857-8684
  • Fax:
Mailing address:
  • Phone: 757-581-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001191
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierC01884
Identifier TypeOTHER
Identifier State
Identifier IssuerMCARE GROUP
# 2
Identifier253774
Identifier TypeOTHER
Identifier State
Identifier IssuerANTHEM PPO BCBS
# 3
Identifier066469
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLAN
# 4
Identifier018485
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS
# 5
Identifier084060
Identifier TypeOTHER
Identifier State
Identifier IssuerSENTARA OPTIMA
# 6
Identifier008917612
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 7
Identifier17011
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 8
IdentifierP00035376
Identifier TypeOTHER
Identifier State
Identifier IssuerMCARE RAILROAD
# 9
Identifier241248
Identifier TypeOTHER
Identifier State
Identifier IssuerMANAGED HEALTH NETWORK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: