MEDICARE: MARINA L MICHAUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	121076	MA

General Provider Information

NPI Number	:	1558848028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA L MICHAUD

Provider Business Mailing Address
First Line	:	33 E MERRIMACK ST
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01852-1204
Country	:	US
Telephone Number	:	978-275-6925
Fax Number	:	978-452-5896

Provider Business Practice Location Address
First Line	:	33 E MERRIMACK ST
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01852-1204
Country	:	US
Telephone Number	:	978-275-6925
Fax Number	:	978-452-5896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	07/26/2018

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Directions to “ MARINA L MICHAUD ” Practice Location

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