Provider Demographics
NPI:1053300707
Name:SZULCZEWSKI, JOSEPH (MA, LPC, LISAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:SZULCZEWSKI
Suffix:
Gender:M
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18008 N 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-1709
Mailing Address - Country:US
Mailing Address - Phone:602-818-6612
Mailing Address - Fax:
Practice Address - Street 1:4425 W GLENDALE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2822
Practice Address - Country:US
Practice Address - Phone:602-818-6612
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC1228101YA0400X
AZLPC11103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional