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NPI Code Detail

MEDICARE: MR. MICHAEL LAWRENCE LAJEUNESSE JR. CADC-1

MEDICARE: MR. MICHAEL LAWRENCE LAJEUNESSE JR. CADC-1
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCI43710724CA

General Provider Information

NPI Number : 1407797202
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL LAWRENCE LAJEUNESSE JR. CADC-1
Provider Business Mailing Address
First Line : 84 W BROADWAY STE 200
Second Line :
City : DERRY
State : NH
Zip : 03038-2323
Country : US
Telephone Number : 603-513-7829
Fax Number :
Provider Business Practice Location Address
First Line : 660 E LOS ANGELES AVE STE B2
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-1884
Country : US
Telephone Number : 805-522-1844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2026
Last Update Date : 04/24/2026

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