MR. MICHAEL A DEFAZIO


Address: 3734 7th Ave, Ste 24, Kenosha, WI 53140
Phone: 2626540487

MR. MICHAEL A DEFAZIO (NPI# 1154407419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1154407419
Entity Type Individual
Full Name MR. MICHAEL A DEFAZIO
Credential MSSW LICSW CADC III
Practice Address 3734 7th Ave
Ste 24
Kenosha
WI 53140
Practice Telephone 2626540487
Practice Fax Number 2626542434
Mailing Telephone 2626540487
Mailing Fax Number 2626542434
Enumeration Date 2006-10-30
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
X 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
044 WI Behavioral Health & Social Service Providers
X 104100000X Social Worker 1165 WI Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
WI 39548700 05

Other Providers MICHAEL DEFAZIO

NPI Name Taxonomy Address Enumeration
1609367465 Michael J Defazio Driver 6755 Shelter Ln, Las Vegas, NV 89103-4369 2018-05-28
1821354325 Michael Vincent Defazio Surgery 14546 Old Saint Augustine Rd Ste 407, Jacksonville, FL 32258-5473 2012-04-09
1497189476 Michael Carey Defazio Student in an Organized Health Care Education/Training Program 3001 Green Bay Rd, Fisher Dental Clinic, North Chicago, IL 60064-3048 2013-08-27

Office Location

Street Address 3734 7TH AVE
STE 24
City KENOSHA
State WI
Zip Code 53140

Providers in the same location

NPI Name Taxonomy Address Enumeration
1922054519 Ismael R Staromana Anesthesiology 3734 7th Ave, Dominican Building #15, Kenosha, WI 53140-5525 2006-05-25
1851527428 Tara R Rullman Counselor 3734 7th Ave, Suite 12, Kenosha, WI 53140-5525 2009-06-09
1336374925 Lisa M Defazio Social Worker 3734 7th Ave, Suite 24, Kenosha, WI 53140-5525 2009-05-26
1942474341 Steven M Schwimmer, D.o. Internal Medicine 3734 7th Ave, Suite 27, Kenosha, WI 53140-5525 2008-04-16
1366627689 Pradeep G. Kumar Md Inc Clinic/Center 3734 7th Ave, Suite 1, Kenosha, WI 53140-5525 2008-01-05
1356526743 Vicki L Bartow Social Worker 3734 7th Ave, Suite 12, Kenosha, WI 53140-5525 2008-01-03
1104001999 Amy F Fockler Social Worker 3734 7th Ave, Suite 12, Kenosha, WI 53140-5525 2007-12-31
1275652315 Corrie Ruth Lee Counselor 3734 7th Ave, Suite 24, Kenosha, WI 53140-5525 2007-03-28
1023153947 Leilane U Sta Romana Mdsc Internal Medicine 3734 7th Ave, Dominican Building Suite 15, Kenosha, WI 53140-5525 2007-02-20
1730246380 Ashokkumar K Shah Psychiatry & Neurology 3734 7th Ave, Suite 24, Kenosha, WI 53140-5525 2007-01-02
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1225663396 Lydia Zopf Counselor 2001 Alford Park Dr., Carthage College, Kenosha, WI 53140 2020-03-09
1952949406 Rotate Rehabilitation and Performance Physical Therapist 5606 6th Avenue Suite Ll9, Kenosha, WI 53140 2019-12-16
1134778590 Brenda Chiapetta Registered Nurse 3233 23rd Ave, Kenosha, WI 53140 2019-09-09
1275003394 Kimberly Shaffner Family Medicine 4536 22nd Avenue, Kenosha, WI 53140 2018-12-01
1659863389 Bart L Mengo Contractor 1715 60th Street, Kenosha, WI 53140 2018-05-30
1093182941 Guided Wellness Counseling Community/Behavioral Health 1112 56th St, Kenosha, WI 53140 2015-08-26
1376970764 Stacey L Andersen Acupuncturist 5603 7th Ave, Kenosha, WI 53140 2013-10-01
1841467438 Deborah Schwerdtfeger Occupational Therapy Assistant 3415 Sheridan Road, Woodstock Rehab Dept, Kenosha, WI 53140 2008-05-13
1942492020 Rebecca Ann Burdette Counselor 920 60th Street, Renosha, WI 53140 2007-08-13
1851598619 Aurora Medical Group, Inc. Durable Medical Equipment & Medical Supplies 2707 15th Place, Kenosha, WI 53140 2007-06-27
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Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1144785395 Michael L Wrzesinski Counselor 4109 67th Street, Kenosha, WI 53142 2019-02-01
1255877148 Amanda Sherman Counselor 6321 23rd Ave, Kenosha, WI 53143-4801 2017-01-16
1326416355 Donna Jorgensen Counselor 815 57th St Unit I, Kenosha, WI 53140-4062 2015-09-08
1275959157 Nancy Guadagno Counselor 6123 Green Bay Rd Ste 240, Kenosha, WI 53142-2927 2014-03-14
1922389352 Morgan Brittany Diaz Counselor 6711 29th Ave, Kenosha, WI 53143-4650 2011-08-30
1609076322 Eileen G Warren Counselor 6501 3rd Ave, Kenosha, WI 53143-5111 2007-07-20
1619024262 Professional Services Group, Inc. Counselor 6233 39th Ave, Kenosha, WI 53142-7015 2007-01-05
1861572372 Carol Bell Counselor 4003 80th St, Suite 101, Kenosha, WI 53142-4995 2006-10-17
1609982040 Brian A Wolf Counselor 2108 63rd St, Kenosha, WI 53143-4454 2006-08-21
1831103761 Nicholas R Mayor Counselor 3535 30th Avenue, Suite 202, Kenosha, WI 53144 2006-07-28
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Competitor

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City KENOSHA
Zip Code 53140

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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