Provider Demographics
NPI:1730273970
Name:WALCZAK, MICHAEL F (PSYD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:WALCZAK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934068
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33093-4068
Mailing Address - Country:US
Mailing Address - Phone:954-366-2700
Mailing Address - Fax:954-366-2056
Practice Address - Street 1:441 S STATE ROAD 7
Practice Address - Street 2:SUITE 9C
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-1973
Practice Address - Country:US
Practice Address - Phone:561-392-9973
Practice Address - Fax:954-917-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75661Medicare ID - Type Unspecified