MEDICARE: MICHAEL V. DISCEPOLA M.A.

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	101Y00000X	Counselor
3	101YM0800X	Mental Health Counselor
4	106H00000X	Marriage & Family Therapist
5	106H00000X	Marriage & Family Therapist	54716	CA

General Provider Information

NPI Number	:	1639210826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL V. DISCEPOLA M.A.

Provider Business Mailing Address
First Line	:	1035 MARKET ST
Second Line	:	FOURTH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1600
Country	:	US
Telephone Number	:	141-548-7310
Fax Number	:	415-558-9657

Provider Business Practice Location Address
First Line	:	1035 MARKET ST
Second Line	:	FOURTH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1600
Country	:	US
Telephone Number	:	415-487-3102
Fax Number	:	415-558-9657

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	04/15/2011

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