Defazio, Paul Michael

Defazio, Paul Michael is an individual health care provider with primary practice located at 3734 7Th Avenue Suite 24, Kenosha WI 53140. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Defazio, Paul Michael can be contacted via phone (262) 654-0487.

Contact Information

Primary practice address
3734 7Th Avenue Suite 24 Kenosha WI 53140
Phone: (262) 654-0487
Fax: (262) 654-2434
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 3123123 Wisconsin

Profile Details

NPI number 1740326370
LBN Legal business name Defazio, Paul Michael
Credentials MSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740326370 NPPES
Wisconsin MEDICAID 39504600

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