Michelle A Coral, LCSW, LCADC

Individual provider Active NPI Clinical Social Worker · Randolph, NJ

NPI 1255165395 · NPPES record last updated Aug 30, 2024

Key facts

NPI
1255165395
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
445C05758100 (NJ)
Practice address
124 Morris Tpke
Randolph, NJ 07869-2831
Phone
(862) 432-7720
NPI assigned
Aug 30, 2024
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
37C00277500NJMDAddiction (Substance Use Disorder) Counselor
445C05758100NJMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 37C00277500 NJ
Clinical Social Worker 1041C0700X 445C05758100 NJ Yes

Addresses

Primary practice location

124 Morris Tpke
Randolph, NJ 07869-2831

Mailing address

400 E Randolph Ave Apt 22
Mine Hill, NJ 07803-3063

Other names

  • Michelle A Reyes Former name

Other providers in Randolph, NJ

All providers in Randolph, NJ · Clinical Social Worker in New Jersey

Sources for this page

Verify at the official NPI Registry.