MEDICARE: MICHAEL R CORTINA LCSW

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	1041C0700X	Clinical Social Worker	34004604A	IN

General Provider Information

NPI Number	:	1245225051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R CORTINA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 23
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-0023
Country	:	US
Telephone Number	:	219-405-7809
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 N BROAD ST
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-2223
Country	:	US
Telephone Number	:	219-405-7809
Fax Number	:

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2024

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