Provider Demographics
NPI:1053923490
Name:PARADISE, MICHELLE (LLMSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PARADISE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 LAKESHORE BLVD APT 875
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6938
Mailing Address - Country:US
Mailing Address - Phone:708-362-9971
Mailing Address - Fax:
Practice Address - Street 1:77 VICTOR ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3127
Practice Address - Country:US
Practice Address - Phone:313-252-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical