Provider Demographics
NPI:1508919127
Name:PASKIEWICZ, PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:PASKIEWICZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAPLE RD
Mailing Address - Street 2:322
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6308
Mailing Address - Country:US
Mailing Address - Phone:248-644-2900
Mailing Address - Fax:248-644-0754
Practice Address - Street 1:300 E MAPLE RD
Practice Address - Street 2:322
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6308
Practice Address - Country:US
Practice Address - Phone:248-644-2900
Practice Address - Fax:248-644-0754
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F321930OtherBLUE CROSS BLUE SHIELD