MEDICARE: MARIBETH RENEE GAJEWSKI LPC, NCC

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		MI

General Provider Information

NPI Number	:	1295244945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIBETH RENEE GAJEWSKI LPC, NCC

Provider Business Mailing Address
First Line	:	11576 ERDMANN RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2642
Country	:	US
Telephone Number	:	586-707-3943
Fax Number	:

Provider Business Practice Location Address
First Line	:	11576 ERDMANN RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2642
Country	:	US
Telephone Number	:	586-707-3943
Fax Number	:

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

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/27/2022

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