Healthcare Provider Details

I. General information

NPI: 1497153928
Provider Name (Legal Business Name): DARLENE KNAPP RACZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR L1252 WH
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

4260 PLYMOUTH RD
ANN ARBOR MI
48109-2700
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-4133
  • Fax: 734-936-9110
Mailing address:
  • Phone: 734-764-2556
  • Fax: 734-763-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801017699
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: