Provider Demographics
NPI:1720160419
Name:SZADYR, VICTOR M (LMSW)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:SZADYR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S JOHNSON ST
Mailing Address - Street 2:SUITE 0-C
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1658
Mailing Address - Country:US
Mailing Address - Phone:248-333-7222
Mailing Address - Fax:248-333-7254
Practice Address - Street 1:35 S JOHNSON ST
Practice Address - Street 2:SUITE 0-C
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1658
Practice Address - Country:US
Practice Address - Phone:248-333-7222
Practice Address - Fax:248-333-7254
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010026601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical