Healthcare Provider Details

I. General information

NPI: 1902731904
Provider Name (Legal Business Name): MICHEL LCSW THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 BAYSWATER AVE
FAR ROCKAWAY NY
11691-1730
US

IV. Provider business mailing address

2930 BAYSWATER AVE
FAR ROCKAWAY NY
11691-1730
US

V. Phone/Fax

Practice location:
  • Phone: 917-478-0974
  • Fax: 929-290-0328
Mailing address:
  • Phone: 917-478-0974
  • Fax: 929-290-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EDWIDGE MICHEL
Title or Position: LCSW
Credential:
Phone: 917-478-0974