Healthcare Provider Details

I. General information

NPI: 1538375324
Provider Name (Legal Business Name): MICHELLE SARAH PARADISE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE SARAH PERGAMO MSW

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 ROCHESTER HILL RD
ROCHESTER NH
03867-1728
US

IV. Provider business mailing address

163 ROCHESTER HILL RD
ROCHESTER NH
03867-1728
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-0238
  • Fax: 603-332-7098
Mailing address:
  • Phone: 603-332-0238
  • Fax: 603-332-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1736
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: