MEDICARE: MRS. ANDREA ERIN HABRECHT-STASKO M.ED, LMHC, CAP

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	4204	FL
2	101YM0800X	Mental Health Counselor	MH9912	FL

General Provider Information

NPI Number	:	1760707202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA ERIN HABRECHT-STASKO M.ED, LMHC, CAP

Provider Business Mailing Address
First Line	:	4726 WADITA KA WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8015
Country	:	US
Telephone Number	:	561-346-6641
Fax Number	:

Provider Business Practice Location Address
First Line	:	4726 WADITA KA WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-8015
Country	:	US
Telephone Number	:	561-346-6641
Fax Number	:

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

Provider Enumeration Date	:	03/27/2010
Last Update Date	:	03/27/2010

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