MEDICARE: MS. DEBORAH A TOMCZAK MS, LLP, LMSW

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	103TC0700X	Clinical Psychologist	6301002798	MI
2	1041C0700X	Clinical Social Worker	6801065510	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	492336000	OTHER	MI	MAGELLAN

General Provider Information

NPI Number	:	1881860427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH A TOMCZAK MS, LLP, LMSW

Provider Business Mailing Address
First Line	:	806 W CEDAR ST STE 4
Second Line	:	PO BOX 274
City	:	STANDISH
State	:	MI
Zip	:	48658-9550
Country	:	US
Telephone Number	:	989-846-4991
Fax Number	:	989-846-4991

Provider Business Practice Location Address
First Line	:	806 W CEDAR ST
Second Line	:	SUITE 4
City	:	STANDISH
State	:	MI
Zip	:	48658-9550
Country	:	US
Telephone Number	:	989-846-4991
Fax Number	:	989-846-4991

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

Provider Enumeration Date	:	05/04/2008
Last Update Date	:	05/04/2008

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