Provider Demographics
NPI:1013115278
Name:MICU, EDWARD (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:MICU
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE VILLAGE SQUARE
Mailing Address - Street 2:14-16 FLETCHER STREET - SUITE 5
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2713
Mailing Address - Country:US
Mailing Address - Phone:978-201-3377
Mailing Address - Fax:530-466-3377
Practice Address - Street 1:ONE VILLAGE SQUARE
Practice Address - Street 2:14-16 FLETCHER STREET - SUITE 5
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2713
Practice Address - Country:US
Practice Address - Phone:978-201-3377
Practice Address - Fax:530-466-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health