Individual
MR. MICHAEL A DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSSW LICSW CADC III
Contact information
Practice address
3734 7TH AVE, STE 24, KENOSHA, WI 53140
(262) 654-0487
(262) 654-2434
Mailing address
3734 7TH AVE, STE 24, KENOSHA, WI 53140
(262) 654-0487
(262) 654-2434
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
044
WI
104100000X
Social Worker
Primary
1165
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39548700
—
WI
Enumeration date
10/30/2006
Last updated
09/11/2025
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