Active NPI
Ian Michael Michelin, LMSW
- Mental Health Counselor
- Clark, NJ
National Provider Identifier
1407665458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 44SL07093400
- Practice address
- 60 Walnut Ave
Clark, NJ 07066-1649 - Phone
- (732) 605-6029
- NPI assigned
- Jan 4, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 44SL07093400 | NJ | Primary |
Addresses
Primary practice location
60 Walnut Ave
Clark, NJ 07066-1649
Mailing address
117 Woodward Ave
Rutherford, NJ 07070-2211
Phone (551) 352-2066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SL07093400 | NJ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735948800000",
"number": "1407665458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 WOODWARD AVE",
"city": "RUTHERFORD",
"state": "NJ",
"postal_code": "070702211",
"telephone_number": "551-352-2066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 WALNUT AVE",
"city": "CLARK",
"state": "NJ",
"postal_code": "070661649",
"telephone_number": "732-605-6029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHELIN",
"first_name": "IAN",
"middle_name": "MICHAEL",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-04",
"last_updated": "2025-01-04",
"certification_date": "2025-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NJ",
"license": "44SL07093400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.