| Doctor Name: | MS. MICHELE NELSON |
| NPI Number: | 1023266079 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 73 075550 |
| Business Practice Address: | 16318 Jamaica Ave Suite 502 Jamaica, NY - 114324901 |
| Business Phone Number: | 7186580010 |
| Business Fax Number: | 7186582962 |
| Mailing Address: | 16318 Jamaica Ave, Suite 502 JAMAICA |
| State: | NY |
| Postal Code: | 114324901 |
| Phone Number: | 7186580010 |
| Fax Number: | 7186582962 |
| NPI Enumeration Date: | 09/03/2008 |
| NPI Last Update Date: | 09/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 73 075550 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |