Provider Demographics
NPI:1669817748
Name:TRZCIENSKI, MICHAEL MATTHEW
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:TRZCIENSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 VILLAGE COMMONS
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1732
Mailing Address - Country:US
Mailing Address - Phone:908-421-5326
Mailing Address - Fax:
Practice Address - Street 1:776 MOUNTAIN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6269
Practice Address - Country:US
Practice Address - Phone:732-469-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLA10095101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral