Healthcare Provider Details

I. General information

NPI: 1811813819
Provider Name (Legal Business Name): MICHAEL WENGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EVERGREEN AVE STE 34
HAMDEN CT
06518-2732
US

IV. Provider business mailing address

447 WOOD HILL RD
CHESHIRE CT
06410-4334
US

V. Phone/Fax

Practice location:
  • Phone: 860-485-7573
  • Fax:
Mailing address:
  • Phone: 860-485-7573
  • Fax: 203-651-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5798
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: