Most Relevant Information
Provider Data
| NPI Number: | 1003657941 |
| Provider Name: | PHILIP WAITZMAN LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 149.025061 |
Most Important Dates
| Enumeration Date: | 06/04/2024 |
| Last Updated: | 06/04/2024 |
Provider Practice Location
415 MAIN ST STE A
SAINT JOSEPH
MI
490853100
Practice Location Phone/Fax
| Phone: | 2694081688 |
| Fax: |
Provider Mailing Location
415 MAIN ST STE A
SAINT JOSEPH
MI
490853100
Provider Mailing Phone/Fax
| Phone: | 2694081688 |
| Fax: |