Healthcare Provider Details

I. General information

NPI: 1497252134
Provider Name (Legal Business Name): MICHAEL MIARECKI COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 MAIN ST STE 311
MIDDLETOWN CT
06457-3359
US

IV. Provider business mailing address

10-18 FOREST GLEN CIR
MIDDLETOWN CT
06457-6669
US

V. Phone/Fax

Practice location:
  • Phone: 203-892-6694
  • Fax:
Mailing address:
  • Phone: 860-748-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008271
License Number StateCT

VIII. Authorized Official

Name: MR. MICHAEL PAUL MIARECKI
Title or Position: OWNER
Credential: LCSW
Phone: 203-892-6694