MEDICARE: MICHAEL LACINAK L.I.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	I0007758	OH

General Provider Information

NPI Number	:	1073647087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LACINAK L.I.S.W.

Provider Business Mailing Address
First Line	:	5967 WAYSIDE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1703
Country	:	US
Telephone Number	:	513-231-0643
Fax Number	:

Provider Business Practice Location Address
First Line	:	2061 BEECHMONT AVE
Second Line	:	SUITE 2
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1688
Country	:	US
Telephone Number	:	513-231-4501
Fax Number	:	513-231-4512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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