Provider Demographics
NPI:1093069536
Name:STASIUK, IRENEUSZ JERZY (MSW)
Entity Type:Individual
Prefix:MR
First Name:IRENEUSZ
Middle Name:JERZY
Last Name:STASIUK
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 1:9193 SIERRA AVE.
Mailing Address - Street 2:STE D
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4776
Mailing Address - Country:US
Mailing Address - Phone:909-810-9145
Mailing Address - Fax:
Practice Address - Street 1:CRC -WESTERN & 5TH STREET
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92806
Practice Address - Country:US
Practice Address - Phone:909-810-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW260701041C0700X
CALCSW623921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical