Provider Demographics
NPI:1942475348
Name:CERESNIE, STEVEN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:CERESNIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1272
Mailing Address - Country:US
Mailing Address - Phone:734-453-9290
Mailing Address - Fax:734-453-9293
Practice Address - Street 1:199 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1272
Practice Address - Country:US
Practice Address - Phone:734-453-9290
Practice Address - Fax:734-453-9293
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002659103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI620H24558OtherBLUE CROSS OF MICHIGAN
MI620H24558OtherBLUE CROSS OF MICHIGAN
MIP61950001Medicare UPIN