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NPI Code Detail

MEDICARE: MICHELE M VINCENT LCSW

MEDICARE:   MICHELE M VINCENT  LCSW
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
11041C0700XClinical Social Worker09930582CO

General Provider Information

NPI Number : 1609589829
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE M VINCENT LCSW
Provider Business Mailing Address
First Line : 4820 RUSINA RD STE C
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-8127
Country : US
Telephone Number : 720-414-0100
Fax Number :
Provider Business Practice Location Address
First Line : 4820 RUSINA RD STE C
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-8127
Country : US
Telephone Number : 720-414-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2023
Last Update Date : 07/26/2024

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Directions to “ MICHELE M VINCENT LCSW” Practice Location

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