Healthcare Provider Details

I. General information

NPI: 1194827188
Provider Name (Legal Business Name): ANTHONY JOSEPH GIUFFRE JR. LMSW, ICAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

IV. Provider business mailing address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-7600
  • Fax: 734-722-6999
Mailing address:
  • Phone: 734-467-7600
  • Fax: 734-722-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC#1-00218
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number#076486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: