MEDICARE: MICHAEL TEICHMAN LISW-S

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	104100000X	Social Worker	I.2203638-SUPV	OH

General Provider Information

NPI Number	:	1275030413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TEICHMAN LISW-S

Provider Business Mailing Address
First Line	:	6674 SENECA RD
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3519
Country	:	US
Telephone Number	:	216-798-7536
Fax Number	:

Provider Business Practice Location Address
First Line	:	6674 SENECA RD
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3519
Country	:	US
Telephone Number	:	216-798-7536
Fax Number	:

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	09/27/2024

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