Provider Demographics
NPI:1013166578
Name:STEVEN J CERESNIE PHD PC
Entity Type:Organization
Organization Name:STEVEN J CERESNIE PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CERESNIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-453-9290
Mailing Address - Street 1:199 N MAIN ST
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002659103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI620H24558OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI620H24558OtherBLUE CROSS BLUE SHIELD OF MICHIGAN