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NPI Code Detail

MEDICARE: MITCHELL B. HANNAFIUS LMSW

MEDICARE: MITCHELL B. HANNAFIUS LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801089466MI
21041C0700XClinical Social Worker33004521AIN

General Provider Information

NPI Number : 1689872913
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITCHELL B. HANNAFIUS LMSW
Provider Business Mailing Address
First Line : 2415 BURTON RD
Second Line :
City : NILES
State : MI
Zip : 49120-9203
Country : US
Telephone Number : 269-591-2360
Fax Number :
Provider Business Practice Location Address
First Line : 261 M 62
Second Line :
City : CASSOPOLIS
State : MI
Zip : 49031-1034
Country : US
Telephone Number : 269-445-3874
Fax Number : 269-445-2076
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2007
Last Update Date : 11/04/2015

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Directions to “ MITCHELL B. HANNAFIUS LMSW” Practice Location

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