Healthcare Provider Details

I. General information

NPI: 1962179416
Provider Name (Legal Business Name): MICHELLE BIVAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 TENNENT RD STE 104
MANALAPAN NJ
07726-3163
US

IV. Provider business mailing address

269 OGDEN AVE APT 1
JERSEY CITY NJ
07307-1230
US

V. Phone/Fax

Practice location:
  • Phone: 732-851-4808
  • Fax:
Mailing address:
  • Phone: 908-295-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06664200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06347400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: