Healthcare Provider Details

I. General information

NPI: 1649612755
Provider Name (Legal Business Name): LARRY CSOKASY L.M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STEWART RD SUITE 106
MONROE MI
48162-5304
US

IV. Provider business mailing address

700 STEWART RD SUITE 106
MONROE MI
48162-5304
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1760
  • Fax: 734-240-1780
Mailing address:
  • Phone: 734-240-1760
  • Fax: 734-240-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801034531
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: