Provider Demographics
NPI:1174545156
Name:BURRELL, MICHELE L (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:BURRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 EAST 53RD STREET
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:646-754-2700
Mailing Address - Fax:646-754-9803
Practice Address - Street 1:159 EAST 53RD STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:646-754-2700
Practice Address - Fax:646-754-9803
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0553061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1U791Medicare ID - Type Unspecified