Provider Demographics
NPI:1306868864
Name:KWAS, GERALD STANLEY (MA LPC LMSW)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:STANLEY
Last Name:KWAS
Suffix:
Gender:M
Credentials:MA LPC LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8962 PERE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3339
Mailing Address - Country:US
Mailing Address - Phone:734-744-0170
Mailing Address - Fax:734-744-0171
Practice Address - Street 1:15370 LEVAN RD.
Practice Address - Street 2:#2
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-744-0170
Practice Address - Fax:734-744-0171
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004253101YP2500X
MI68010037161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical