Healthcare Provider Details

I. General information

NPI: 1407383839
Provider Name (Legal Business Name): MIQUEL POWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAKE AVE
ROCHESTER NY
14608-1162
US

IV. Provider business mailing address

446 ALEXANDER ST
ROCHESTER NY
14605-2706
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-6480
  • Fax:
Mailing address:
  • Phone: 585-967-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: