Doctor Name: | DR. MICHAEL PEDICIN |
NPI Number: | 1740348119 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD LPC |
License Number: | PC002405 |
Business Practice Address: | 310 New Jersey Avenue Absecon, NJ - 082012413 |
Business Phone Number: | 6096467162 |
Business Fax Number: | |
Mailing Address: | 312 Forest Drive, LINWOOD |
State: | NJ |
Postal Code: | 08221 |
Phone Number: | 6099272581 |
Fax Number: | |
NPI Enumeration Date: | 12/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC002405 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |