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General NPI Number Information
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NPI Number | 1497252134
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Entity Type | Organization
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Legal Business Name | MICHAEL MIARECKI COUNSELING LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 363 MAIN ST STE 311
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3359
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Country | US
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Telephone | 203-892-6694
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Fax |
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Provider Business Mailing Address
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Address Line | 10-18 FOREST GLEN CIR
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City | MIDDLETOWN
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State | CT
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Zip | 06457-6669
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Country | US
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Telephone | 860-748-2535
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL PAUL MIARECKI
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Credential | LCSW
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Telephone | 203-892-6694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 008271
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License Number State | CT
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