MR. Michael Allen Ide, LSW

NPI #1134387897 in Kingston, Pennsylvania

Provider Information

NPI Number: 1134387897
Entity Type: Individual
Name: MR. Michael Allen Ide, LSW
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Social Worker
Credential: LSW
Enumeration Date: May 29, 2008
Last Updated: Aug 17, 2017

Practice Location

Address: 562 WYOMING AVENUE
Address 2: CHOICES
City: Kingston
State: Pennsylvania
ZIP Code: 18704
Phone: (570) 552-3700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Social Worker	104100000X	Primary

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