MEDICARE: MICHAEL BACON M.A.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1154795789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BACON M.A.

Provider Business Mailing Address
First Line	:	2 W JONATHAN CT
Second Line	:
City	:	KENNETT SQ
State	:	PA
Zip	:	19348-1848
Country	:	US
Telephone Number	:	484-574-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 W MARKET ST STE 2
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-2930
Country	:	US
Telephone Number	:	610-616-5890
Fax Number	:

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

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	07/21/2025

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