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General NPI Number Information
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NPI Number | 1881679611
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY CESNIK LCSW, LMFT
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 1175 SOUTHVIEW DR
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City | MARTINSVILLE
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State | IN
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Zip | 46151-7062
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Country | US
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Telephone | 765-342-6616
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Fax | 765-342-2169
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Provider Business Mailing Address
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Address Line | 645 S ROGERS ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2353
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Country | US
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Telephone | 812-339-1691
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Fax | 812-337-2259
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 34002479
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License Number State | IN
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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 | 34002479
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34002479
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35000457A
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License Number State | IN
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