Provider Demographics
NPI:1609992346
Name:PREZIOSO, FRED (LMSW, CAC II, LPC)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:PREZIOSO
Suffix:
Gender:M
Credentials:LMSW, CAC II, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1448
Mailing Address - Country:US
Mailing Address - Phone:517-423-6455
Mailing Address - Fax:
Practice Address - Street 1:2008 HOGBACK RD STE 8
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9751
Practice Address - Country:US
Practice Address - Phone:734-786-4900
Practice Address - Fax:734-786-8051
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010091181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical