Provider Demographics
NPI:1154795789
Name:BACON, MICHAEL (MA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BACON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W JONATHAN CT
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQ
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1848
Mailing Address - Country:US
Mailing Address - Phone:484-574-4312
Mailing Address - Fax:
Practice Address - Street 1:142 W MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2930
Practice Address - Country:US
Practice Address - Phone:610-616-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor