Provider Demographics
NPI:1073849170
Name:HRIBLJAN, JOHN M (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:HRIBLJAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22811 GREATER MACK AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2021
Mailing Address - Country:US
Mailing Address - Phone:586-775-2511
Mailing Address - Fax:586-775-9922
Practice Address - Street 1:22811 GREATER MACK AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2021
Practice Address - Country:US
Practice Address - Phone:586-775-2511
Practice Address - Fax:586-775-9922
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010032481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical