Provider Demographics
NPI:1750314100
Name:PFALZER, GERALD MARTIN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:MARTIN
Last Name:PFALZER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:MARTIN
Other - Last Name:PFALZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:509 GEORGETOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3616
Mailing Address - Country:US
Mailing Address - Phone:734-306-5613
Mailing Address - Fax:
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2653
Practice Address - Country:US
Practice Address - Phone:248-398-6459
Practice Address - Fax:248-398-6265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health