Mr Michael A Defazio, MSSW LICSW CADC III is a
Social Worker based in Kenosha, Wisconsin. Mr Michael A Defazio is licensed to practice in Wisconsin (license number 1165) and his current practice location is
3734 7th Ave, Ste 24, Kenosha, Wisconsin. He can be reached at his office (for appointments etc.) via phone at
(262) 654-0487.
NPI number for Mr Michael A Defazio is 1154407419 and his current mailing address is 3734 7th Ave, Ste 24, Kenosha, Wisconsin. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1154407419.
Healthcare Provider's Profile
| Full Name | Mr Michael A Defazio |
|---|
| Gender | Male |
|---|
| Speciality | Social Worker |
|---|
| Location | 3734 7th Ave, Kenosha, Wisconsin |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1154407419
- Provider Enumeration Date: 10/30/2006
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Mr Michael A Defazio such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1154407419 | NPI | - | NPPES |
| 39548700 | Medicaid | WI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 044 (Wisconsin) | Primary |
| 104100000X | Social Worker | 1165 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Michael A Defazio is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Michael A Defazio, MSSW LICSW CADC III
3734 7th Ave, Ste 24,
Kenosha, WI 53140
Ph: (262) 654-0487 | Mr Michael A Defazio, MSSW LICSW CADC III
3734 7th Ave, Ste 24,
Kenosha, WI 53140
Ph: (262) 654-0487 |
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