Basic Information
| Provider Information | |||||||||
| NPI: | 1356376651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIONDO | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BIONDO | ||||||||
| OtherFirstName: | FRANCIS | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 24715 LITTLE MACK | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ST CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867779000 | ||||||||
| FaxNumber: | 5867770823 | ||||||||
| Practice Location | |||||||||
| Address1: | 24715 LITTLE MACK | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ST CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867779000 | ||||||||
| FaxNumber: | 5867770823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6801065208 | MI | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | 6801065208 | MI | X | Behavioral Health & Social Service Providers | Psychologist | 1041C0700X | 6801065208 | MI | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.