Healthcare Provider Details

I. General information

NPI: 1265771190
Provider Name (Legal Business Name): MICHAELENE WOJTKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 FENN ST ADMINISTRATIVE OFFICES
PITTSFIELD MA
01201-5261
US

IV. Provider business mailing address

359 FENN ST ADMINISTRATIVE OFFICES
PITTSFIELD MA
01201-5261
US

V. Phone/Fax

Practice location:
  • Phone: 413-629-1251
  • Fax: 413-448-2198
Mailing address:
  • Phone: 413-629-1251
  • Fax: 413-448-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: