Provider Demographics
NPI:1780828178
Name:POZDOL, MARK JOHN (MPA LBSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOHN
Last Name:POZDOL
Suffix:
Gender:M
Credentials:MPA LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 DORIS RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2617
Mailing Address - Country:US
Mailing Address - Phone:248-276-8076
Mailing Address - Fax:248-276-9280
Practice Address - Street 1:1270 DORIS RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2617
Practice Address - Country:US
Practice Address - Phone:248-276-8076
Practice Address - Fax:248-276-9280
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802019020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker