MEDICARE: MICHELLE KREPAK

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

General Provider Information

NPI Number	:	1538310941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KREPAK

Provider Business Mailing Address
First Line	:	20 BRIDGE ST
Second Line	:
City	:	GREENWICH
State	:	CT
Zip	:	06830-5238
Country	:	US
Telephone Number	:	203-629-2822
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 PALMERS HILL RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2113
Country	:	US
Telephone Number	:	203-629-2822
Fax Number	:

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

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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Directions to “ MICHELLE KREPAK ” Practice Location

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