Provider Demographics
NPI:1043940497
Name:WIERZBICKI, PAUL (LLMSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WIERZBICKI
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E OAKRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1332
Mailing Address - Country:US
Mailing Address - Phone:586-935-2610
Mailing Address - Fax:
Practice Address - Street 1:343 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1037
Practice Address - Country:US
Practice Address - Phone:248-717-1232
Practice Address - Fax:248-717-0150
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511144711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical