Provider Demographics
NPI:1679827653
Name:SPIZARNY, KEVIN JAMES (LMSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:SPIZARNY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 N WAYNE RD STE 123
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1137
Mailing Address - Country:US
Mailing Address - Phone:313-262-0967
Mailing Address - Fax:
Practice Address - Street 1:8623 N WAYNE RD STE 123
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:313-262-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010871521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical