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General NPI Number Information
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NPI Number | 1730273970
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Entity Type | Individual
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Provider Name | MICHAEL F WALCZAK PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 441 S STATE ROAD 7 SUITE 9C
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City | MARGATE
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State | FL
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Zip | 33068-1973
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Country | US
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Telephone | 561-392-9973
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Fax | 954-917-3626
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Provider Business Mailing Address
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Address Line | PO BOX 934068
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City | MARGATE
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State | FL
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Zip | 33093-4068
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Country | US
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Telephone | 954-366-2700
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Fax | 954-366-2056
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY3256
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License Number State | FL
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