MEDICARE: MACIE PRAJER

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	101YP2500X	Professional Counselor	5055	CT

General Provider Information

NPI Number	:	1548912074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACIE PRAJER

Provider Business Mailing Address
First Line	:	10 BLACKALL RD
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-8005
Country	:	US
Telephone Number	:	203-560-3677
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 WEST ST STE 207
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3435
Country	:	US
Telephone Number	:	203-560-3677
Fax Number	:

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

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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Directions to “ MACIE PRAJER ” Practice Location

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