Healthcare Provider Details

I. General information

NPI: 1093024523
Provider Name (Legal Business Name): DANIEL VICTOR KRSTESKI LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 E 14 MILE RD SUITE 900
MADISON HEIGHTS MI
48071-1541
US

IV. Provider business mailing address

1410 E 14 MILE RD SUITE 900
MADISON HEIGHTS MI
48071-1541
US

V. Phone/Fax

Practice location:
  • Phone: 248-524-8801
  • Fax:
Mailing address:
  • Phone: 248-524-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: