Provider Demographics
NPI:1750929915
Name:SZYMCZAK, ROBERT GERALD JR (LLMSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GERALD
Last Name:SZYMCZAK
Suffix:JR
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W HILLER ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1524
Mailing Address - Country:US
Mailing Address - Phone:325-260-5604
Mailing Address - Fax:
Practice Address - Street 1:4328 PAGE AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CENTER
Practice Address - State:MI
Practice Address - Zip Code:49254-1077
Practice Address - Country:US
Practice Address - Phone:734-845-5218
Practice Address - Fax:734-222-7495
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011046171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical