| Doctor Name: | MR. EDWARD MICU |
| NPI Number: | 1013115278 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC |
| License Number: | |
| Business Practice Address: | One Village Square 14-16 Fletcher Street - Suite 5 Chelmsford, MA - 018242713 |
| Business Phone Number: | 9782013377 |
| Business Fax Number: | 5304663377 |
| Mailing Address: | One Village Square, 14-16 Fletcher Street - Suite 5 CHELMSFORD |
| State: | MA |
| Postal Code: | 018242713 |
| Phone Number: | 9782013377 |
| Fax Number: | 5304663377 |
| NPI Enumeration Date: | 07/10/2007 |
| NPI Last Update Date: | 09/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |