MEDICARE: MICHAEL A MIECZKOWSKI MS,CADC CSAT CMAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	8096	PA

General Provider Information

NPI Number	:	1003418815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A MIECZKOWSKI MS,CADC CSAT CMAT

Provider Business Mailing Address
First Line	:	5547 55TH TER
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-2473
Country	:	US
Telephone Number	:	336-403-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	5547 55TH TER
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-2473
Country	:	US
Telephone Number	:	336-403-0635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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