Michelle Dale, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113144 Issued in MA

Practice address

173 Mount Auburn St FRNT
Watertown, MA 02472-4005

Phone

(857) 242-1801

Fax

(501) 617-2087

NPI assigned

Nov 17, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Michelle Berry Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1043384696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 POSSUM TROT RD",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721047819",
            "telephone_number": "501-617-2087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 MOUNT AUBURN ST FRNT",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724005",
            "telephone_number": "857-242-1801",
            "fax_number": "501-617-2087"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "724 Possum Trot Rd",
            "address_purpose": "LOCATION",
            "city": "Malvern",
            "state": "AR",
            "postal_code": "721047819",
            "country_code": "US",
            "telephone_number": "501-617-2087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DALE",
        "first_name": "MICHELLE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "11828-C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "P08586",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "BERRY",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel D'Amico, DMD
• Deirdre E D'Silva, LIC. AC.
• Cherie D'Souza
• Camilla Da Rocha, CCC-SLP
• Jeff Randall Daily
• Juliet Dalton
• Christine Daly, M.A.
• Domenic Damico, DMD
• Peter Dana, D.M.D.
• Connor Dante, DPT

• Clinical Social Worker in Watertown, MA
• Providers in Watertown, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.