# STEVEN J CERESNIE PHD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013166578
- **Authorized official:** DR. STEVEN J CERESNIE PHD (OWNER)
- **Authorized official phone:** (734) 453-9290

## Contact information

- **Practice address:** 199 N MAIN ST, PLYMOUTH, MI 48170-1272
- **Practice address phone:** (734) 453-9290
- **Practice address fax:** (734) 453-9293
- **Mailing address:** 199 N MAIN ST, PLYMOUTH, MI 48170-1272
- **Mailing address phone:** (734) 453-9290
- **Mailing address fax:** (734) 453-9293

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 6301002659 | MI | Yes |

## Other

- **Enumeration date:** 09/09/2008
- **Last updated:** 10/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 620H24558 | BLUE CROSS BLUE SHIELD OF MICHIGAN | MI |