MEDICARE: MR. MICHAEL BRUCE ENSON MSW LCSW

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	1041C0700X	Clinical Social Worker	001682	CT

General Provider Information

NPI Number	:	1881750131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL BRUCE ENSON MSW LCSW

Provider Business Mailing Address
First Line	:	9 MUNSON ROAD
Second Line	:	2ND FLOOR
City	:	BETHANY
State	:	CT
Zip	:	06524
Country	:	US
Telephone Number	:	203-393-2849
Fax Number	:	203-393-1735

Provider Business Practice Location Address
First Line	:	9 MUNSON ROAD
Second Line	:	2ND FLOOR
City	:	BETHANY
State	:	CT
Zip	:	06524
Country	:	US
Telephone Number	:	203-393-2849
Fax Number	:	203-393-1735

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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