MEDICARE: MARLENE KALISZ LMHC

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	3752	MA

General Provider Information

NPI Number	:	1417496191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE KALISZ LMHC

Provider Business Mailing Address
First Line	:	12 BEAVER DAM RD
Second Line	:
City	:	ACUSHNET
State	:	MA
Zip	:	02743-1446
Country	:	US
Telephone Number	:	508-965-4465
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 MOUNT PLEASANT ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02746-1539
Country	:	US
Telephone Number	:	774-202-2939
Fax Number	:

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

Provider Enumeration Date	:	02/15/2017
Last Update Date	:	02/15/2017

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