| Doctor Name: | MS. MICHELLE R. WILLARD |
| NPI Number: | 1245539477 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | 2016 |
| Business Practice Address: | 1 Grist Mill Ln Simsbury, CT - 060702485 |
| Business Phone Number: | 8603252176 |
| Business Fax Number: | |
| Mailing Address: | 31 Firetown Rd, WEST GRANBY |
| State: | CT |
| Postal Code: | 060901612 |
| Phone Number: | 8603252176 |
| Fax Number: | |
| NPI Enumeration Date: | 03/28/2011 |
| NPI Last Update Date: | 03/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2016 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |