MEDICARE: JENNIFER T MICHIEL MHC

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	005744	NY

General Provider Information

NPI Number	:	1194152579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER T MICHIEL MHC

Provider Business Mailing Address
First Line	:	25 WEICHERS ST
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-3325
Country	:	US
Telephone Number	:	631-848-7137
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 WEICHERS ST
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-3325
Country	:	US
Telephone Number	:	631-848-7137
Fax Number	:

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	07/11/2019

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