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General NPI Number Information
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NPI Number | 1760627061
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Entity Type | Individual
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Provider Name | MICHELLE A. MROZ MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 103 PARK ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-5913
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Country | US
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Telephone | 973-495-6964
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Fax | 201-336-8194
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Provider Business Mailing Address
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Address Line | 159 PARK ST #5
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3901
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Country | US
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Telephone | 973-495-6964
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Fax | 201-336-8194
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04712400
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License Number State | NJ
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