Provider Demographics
NPI:1295028637
Name:KACZMAREK, MICHELE (LPC, ACS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NAVAJO WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2403
Mailing Address - Country:US
Mailing Address - Phone:973-983-1933
Mailing Address - Fax:
Practice Address - Street 1:23 NAVAJO WAY
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2403
Practice Address - Country:US
Practice Address - Phone:973-983-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00038900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional