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General NPI Number Information
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NPI Number | 1619366812
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Entity Type | Individual
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Provider Name | MICHAEL STAICER LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 3133 N MILLBROOK AVE
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City | FRESNO
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State | CA
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Zip | 93703-1425
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Country | US
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Telephone | 559-600-6743
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Fax |
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Provider Business Mailing Address
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Address Line | 4311 KINGS CANYON
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City | FRESNO
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State | CA
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Zip | 93750-1425
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Country | US
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Telephone | 559-600-6757
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW70473
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW93645
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License Number State | CA
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