Provider Demographics
NPI:1508112657
Name:STARFISH FAMILY SERVICES
Entity Type:Organization
Organization Name:STARFISH FAMILY SERVICES
Other - Org Name:LIFESPAN CLINICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRAZIA
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:248-615-9730
Mailing Address - Street 1:29583 ORANGELAWN ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3032
Mailing Address - Country:US
Mailing Address - Phone:248-615-9730
Mailing Address - Fax:
Practice Address - Street 1:18316 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-5007
Practice Address - Country:US
Practice Address - Phone:248-615-9730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092146251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health