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NPI Code Detail

MEDICARE: MRS. LAURA JEANNE MICELI

MEDICARE: MRS. LAURA JEANNE MICELI
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1790982700
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA JEANNE MICELI
Provider Business Mailing Address
First Line : 2726 GARDEN ST.
Second Line :
City : OAKLAND
State : CA
Zip : 94601
Country : US
Telephone Number : 510-302-8951
Fax Number : 209-838-2531
Provider Business Practice Location Address
First Line : 2726 GARDEN ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1314
Country : US
Telephone Number : 510-302-8951
Fax Number : 209-838-2531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2007
Last Update Date : 07/08/2007

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