Provider Demographics
NPI:1053498485
Name:SHIMEK, STEPHEN J (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:SHIMEK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1611
Mailing Address - Country:US
Mailing Address - Phone:269-381-9800
Mailing Address - Fax:269-381-2932
Practice Address - Street 1:960 AGARD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4051
Practice Address - Country:US
Practice Address - Phone:269-925-1234
Practice Address - Fax:269-925-4275
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084999104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker