Individual
MICHELLE K WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 MAIN ST, PORT JEFFERSON, NY 11777-2250
(516) 993-6678
Mailing address
114 EVERGREEN AVE FL 2, LYNBROOK, NY 11563-3162
(516) 476-6545
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001749
NY
Other
Enumeration date
04/20/2021
Last updated
04/20/2021
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