| Doctor Name: | MR. CHARLES MICELI |
| NPI Number: | 1174962799 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LCSW |
| License Number: | SW5546 |
| Business Practice Address: | 465 Summerhaven Dr Suite 1-a Debary, FL - 327135211 |
| Business Phone Number: | 4074938181 |
| Business Fax Number: | 4077883075 |
| Mailing Address: | 1405 Hearthstone Ln, LONGWOOD |
| State: | FL |
| Postal Code: | 327503343 |
| Phone Number: | 4074938181 |
| Fax Number: | 4077883075 |
| NPI Enumeration Date: | 06/17/2013 |
| NPI Last Update Date: | 06/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW5546 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |