Provider Demographics
NPI:1265566079
Name:DUNN, MICHELLE JEANNETTE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANNETTE
Last Name:DUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DONATELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:443 FOX WATER TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-671-6955
Mailing Address - Fax:781-874-8744
Practice Address - Street 1:443 FOX WATER TRL
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-671-6955
Practice Address - Fax:781-874-8744
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW160971041C0700X
MA1224771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical