Type 1 individualNPI 1154407419
MR. MICHAEL A DEFAZIO MSSW LICSW CADC III
104100000X · KENOSHA, WI
Why this profile is appearing now
Observed change signals
No current public change signal is attached to this profile.
Reported classification
Taxonomies
| Code | Description | Source flag |
|---|---|---|
| 104100000X | 104100000X | Primary |
| 101YA0400X | 101YA0400X | Additional |
Taxonomy reporting does not establish licensure, board certification, expertise, or quality.
Longitudinal record
Observed change timeline
- 0 recorded field change s