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General NPI Number Information
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NPI Number | 1033822259
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Entity Type | Individual
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Provider Name | MICHELLE WASIUK
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Gender | Female
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 1 TARA BLVD STE 200
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City | NASHUA
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State | NH
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Zip | 03062-2809
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Country | US
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Telephone | 603-242-2296
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 321
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City | EAST DERRY
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State | NH
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Zip | 03041-0321
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Country | US
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Telephone | 978-254-1124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11961
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2527
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License Number State | NH
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