Healthcare Provider Details

I. General information

NPI: 1851556054
Provider Name (Legal Business Name): JOSEPH E CZAJKOWSKI L.M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S MAIN ST
PLYMOUTH MI
48170-2253
US

IV. Provider business mailing address

10028 HILLCREST DR
PLYMOUTH MI
48170-3236
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-3440
  • Fax: 734-451-8720
Mailing address:
  • Phone: 734-451-3440
  • Fax: 734-451-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801017515
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: