Provider Demographics
NPI:1447645270
Name:ULETT, MICHAEL C
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:ULETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAIN ST STE 818
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1692
Mailing Address - Country:US
Mailing Address - Phone:508-791-4976
Mailing Address - Fax:508-791-6723
Practice Address - Street 1:340 MAIN ST STE 818
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1692
Practice Address - Country:US
Practice Address - Phone:508-791-4976
Practice Address - Fax:508-791-6723
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health