Provider Demographics
NPI:1598464968
Name:CERVANTES, MICHELLE (LSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WITS END DR APT 4D
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-9738
Mailing Address - Country:US
Mailing Address - Phone:929-426-3512
Mailing Address - Fax:
Practice Address - Street 1:30 WITS END DR APT 4D
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-9738
Practice Address - Country:US
Practice Address - Phone:929-426-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC065069001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical