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General NPI Number Information
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NPI Number | 1093069536
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Entity Type | Individual
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Provider Name | IRENEUSZ JERZY STASIUK MSW
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Gender | Male
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | CRC -WESTERN & 5TH STREET
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City | NORCO
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State | CA
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Zip | 92806
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Country | US
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Telephone | 909-810-9145
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Fax |
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Provider Business Mailing Address
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Address Line | 9193 SIERRA AVE. STE D
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City | FONTANA
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State | CA
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Zip | 92335-4776
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Country | US
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Telephone | 909-810-9145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW26070
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW62392
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License Number State | CA
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