MEDICARE: MR. MICHAEL EDWARD DRAG LPC

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	101YP2500X	Professional Counselor	PC009971	PA

General Provider Information

NPI Number	:	1972016525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EDWARD DRAG LPC

Provider Business Mailing Address
First Line	:	1442 RAINER RD
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-1940
Country	:	US
Telephone Number	:	484-441-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1442 RAINER RD
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-1940
Country	:	US
Telephone Number	:	484-441-3379
Fax Number	:

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

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	03/17/2018

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