Provider Demographics
NPI:1093815581
Name:BAJON, BRONISLAW J (LMSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRONISLAW
Middle Name:J
Last Name:BAJON
Suffix:
Gender:M
Credentials:LMSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 KING RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7972
Mailing Address - Country:US
Mailing Address - Phone:734-479-6633
Mailing Address - Fax:
Practice Address - Street 1:16100 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7972
Practice Address - Country:US
Practice Address - Phone:734-479-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801018161104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker