Healthcare Provider Details

I. General information

NPI: 1649429747
Provider Name (Legal Business Name): MICHELLE MCCOMBE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 HAMMERLUND WAY TECH 3
MIDDLETOWN RI
02842-5640
US

IV. Provider business mailing address

31 JOHN CLARKE ROAD
MIDDLETOWN RI
02842-5641
US

V. Phone/Fax

Practice location:
  • Phone: 401-207-5733
  • Fax: 401-845-8933
Mailing address:
  • Phone: 401-207-5733
  • Fax: 401-845-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01985
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: