Provider Demographics
NPI:1396393575
Name:KUCSERIK, MICHAEL (LADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:KUCSERIK
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PLEASANTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3718
Mailing Address - Country:US
Mailing Address - Phone:802-585-6137
Mailing Address - Fax:
Practice Address - Street 1:45 PLEASANTVIEW ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3718
Practice Address - Country:US
Practice Address - Phone:802-585-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0134082101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty