Healthcare Provider Details

I. General information

NPI: 1134364417
Provider Name (Legal Business Name): MICHELLE ANDREA DEFREITAS L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17810 WEXFORD TER
JAMAICA NY
11432-3050
US

IV. Provider business mailing address

14148 85TH RD APT.6H
BRIARWOOD NY
11435-2556
US

V. Phone/Fax

Practice location:
  • Phone: 718-658-1123
  • Fax:
Mailing address:
  • Phone: 718-658-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071742-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: