Basic Information
| Provider Information | |||||||||
| NPI: | 1396956033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUDANO | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 8TH AVE | ||||||||
| Address2: | 4F | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112151708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172821475 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 FLATBUSH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112172812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186222000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 057437 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.