Michael A Defazio, MSSW LICSW CADC III

Primary specialty

Social WorkerTaxonomy code 104100000X

License

1165 Issued in WI

Practice address

3734 7TH Ave
Ste 24
Kenosha, WI 53140

Phone

(262) 654-0487

Fax

(262) 654-2434

NPI assigned

Oct 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neuropsychological Consultants Inc

  • Psychologist
  • Kenosha, WI
  • NPI 1013059187
  NPD (past)
• Psychiatric & Psychotherapy Clinic L I Newman MD SC Gen PTR

  • Addiction (Substance Use Disorder) Counselor
  • Kenosha, WI
  • NPI 1932312212
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1154407419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3734 7TH AVE",
            "address_2": "STE 24",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53140",
            "telephone_number": "262-654-0487",
            "fax_number": "262-654-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3734 7TH AVE",
            "address_2": "STE 24",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53140",
            "telephone_number": "262-654-0487",
            "fax_number": "262-654-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFAZIO",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "MSSW LICSW CADC III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-30",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "044",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "1165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39548700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Deal
• Samantha Rae Debartolo
• Tyler G Dechiara
• Teresa Deer, PH.D.
• Lisa M Defazio, M.S.W., L.C.S.W.
• Paul Michael Defazio, MSW
• Danielle Defreese, PSYD
• Rebecca Degener, PT
• Juli Marie Degrave, APRN, FNP-C
• Mariano F Deguzman, MD

• Social Worker in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.