MEDICARE: MARTHA PAWLICKI

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

General Provider Information

NPI Number	:	1134676380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA PAWLICKI

Provider Business Mailing Address
First Line	:	4031 NE 28TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5730
Country	:	US
Telephone Number	:	419-377-9357
Fax Number	:

Provider Business Practice Location Address
First Line	:	4031 NE 28TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5730
Country	:	US
Telephone Number	:	419-377-9357
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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Directions to “ MARTHA PAWLICKI ” Practice Location

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