Provider Demographics
NPI:1942471032
Name:CHINICHIAN, MICHELE R (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:R
Last Name:CHINICHIAN
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 1:793 N ALMA SCHOOL RD STE D6
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3611
Mailing Address - Country:US
Mailing Address - Phone:480-409-2915
Mailing Address - Fax:
Practice Address - Street 1:1415 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1604
Practice Address - Country:US
Practice Address - Phone:602-302-7815
Practice Address - Fax:602-258-6140
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-115781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical