Provider Demographics
NPI:1003703117
Name:PAGE, STANLEY (LCSW)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 CREEKWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1500
Mailing Address - Country:US
Mailing Address - Phone:810-391-2923
Mailing Address - Fax:810-391-2968
Practice Address - Street 1:1091 CREEKWOOD TRL
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1500
Practice Address - Country:US
Practice Address - Phone:810-391-2923
Practice Address - Fax:810-391-2968
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011172441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical