Provider Demographics
NPI:1013991470
Name:ANISKIEWICZ, ALBERT STANLEY (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:STANLEY
Last Name:ANISKIEWICZ
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-3070
Mailing Address - Fax:517-884-1817
Practice Address - Street 1:909 FEE RD ROOM B119
Practice Address - Street 2:MICHIGAN STATE UNIVERSITY DEPARTMENT OF PSYCHIATRY
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1315
Practice Address - Country:US
Practice Address - Phone:517-353-3070
Practice Address - Fax:517-884-1817
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001543103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS11825Medicare UPIN
MI0N42800001Medicare ID - Type Unspecified
MI0C34654011Medicare ID - Type Unspecified