Healthcare Provider Details

I. General information

NPI: 1013166578
Provider Name (Legal Business Name): STEVEN J CERESNIE PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N MAIN ST
PLYMOUTH MI
48170-1272
US

IV. Provider business mailing address

199 N MAIN ST
PLYMOUTH MI
48170-1272
US

V. Phone/Fax

Practice location:
  • Phone: 734-453-9290
  • Fax: 734-453-9293
Mailing address:
  • Phone: 734-453-9290
  • Fax: 734-453-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301002659
License Number StateMI

VIII. Authorized Official

Name: DR. STEVEN J CERESNIE
Title or Position: OWNER
Credential: PHD
Phone: 734-453-9290