Healthcare Provider Details

I. General information

NPI: 1083326300
Provider Name (Legal Business Name): MICHELLE CHRISTINE DEFEO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 LENOX AVE FL 3
NEW YORK NY
10027-4991
US

IV. Provider business mailing address

290 LENOX AVE FL 3
NEW YORK NY
10027-4991
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3000
  • Fax:
Mailing address:
  • Phone: 212-663-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: