Provider Demographics
NPI:1962224055
Name:PREZIOSO, MICHAEL DAVID (LPC-A ATR-P)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:PREZIOSO
Suffix:
Gender:M
Credentials:LPC-A ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WOOSTER ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2937
Mailing Address - Country:US
Mailing Address - Phone:203-435-3259
Mailing Address - Fax:
Practice Address - Street 1:58 WELLINGTON ROAD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-1641
Practice Address - Country:US
Practice Address - Phone:203-435-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health