Provider Demographics
NPI:1629254297
Name:STANISLAW, JAMES R (MSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:STANISLAW
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:625 E BIG BEAVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1426
Mailing Address - Country:US
Mailing Address - Phone:248-740-9360
Mailing Address - Fax:248-740-9374
Practice Address - Street 1:625 E BIG BEAVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1426
Practice Address - Country:US
Practice Address - Phone:248-740-9360
Practice Address - Fax:248-740-9374
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801012574104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker