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General NPI Number Information
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NPI Number | 1194893735
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Entity Type | Individual
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Provider Name | MICHELLE PEREZ VICHOT MSW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 265 BEACH ST
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City | REVERE
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State | MA
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Zip | 02151-3131
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Country | US
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Telephone | 617-912-7704
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Fax | 781-286-5636
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Provider Business Mailing Address
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Address Line | 13 CLYDESDALE RD
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City | CHELMSFORD
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State | MA
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Zip | 01824-1157
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Country | US
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Telephone | 617-884-9435
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Fax | 617-889-5190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 110182
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License Number State | MA
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