MEDICARE: MR. EDWARD MICU LMHC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013115278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD MICU LMHC

Provider Business Mailing Address
First Line	:	ONE VILLAGE SQUARE
Second Line	:	14-16 FLETCHER STREET - SUITE 5
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2713
Country	:	US
Telephone Number	:	978-201-3377
Fax Number	:	530-466-3377

Provider Business Practice Location Address
First Line	:	ONE VILLAGE SQUARE
Second Line	:	14-16 FLETCHER STREET - SUITE 5
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2713
Country	:	US
Telephone Number	:	978-201-3377
Fax Number	:	530-466-3377

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	09/22/2014

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