Basic Information
| Provider Information | |||||||||
| NPI: | 1255478608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAGE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | PELAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 350 | ||||||||
| Address2: | |||||||||
| City: | NORTH EASTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026510350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7747223040 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 543 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027402766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089845566 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1029798 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.