Basic Information
| Provider Information | |||||||||
| NPI: | 1831766377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERBLESKI | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3253 CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486023106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894754171 | ||||||||
| FaxNumber: | 9893936021 | ||||||||
| Practice Location | |||||||||
| Address1: | 3253 CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486023106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894754171 | ||||||||
| FaxNumber: | 9893936021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2021 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6851109712 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.