Provider Demographics
NPI:1093024523
Name:KRSTESKI, DANIEL VICTOR (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:VICTOR
Last Name:KRSTESKI
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 1:1410 E 14 MILE RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1541
Mailing Address - Country:US
Mailing Address - Phone:248-524-8801
Mailing Address - Fax:
Practice Address - Street 1:1410 E 14 MILE RD
Practice Address - Street 2:SUITE 900
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1541
Practice Address - Country:US
Practice Address - Phone:248-524-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010925401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical