Healthcare Provider Details

I. General information

NPI: 1124596648
Provider Name (Legal Business Name): MICHAEL AITCHESON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S BROOKFIELD RD
CHERRY HILL NJ
08034-3745
US

IV. Provider business mailing address

206 S BROOKFIELD RD
CHERRY HILL NJ
08034-3745
US

V. Phone/Fax

Practice location:
  • Phone: 856-305-0844
  • Fax:
Mailing address:
  • Phone: 856-305-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05644800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: