Healthcare Provider Details

I. General information

NPI: 1194866863
Provider Name (Legal Business Name): DENNIS JOHN KASZETA LMSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8062 ORTONVILLE ROAD TRIAD ASSOCIATES, P.C.
CLARKSTON MI
48348
US

IV. Provider business mailing address

10164 OLD KENT LN
CLARKSTON MI
48348-1612
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2970
  • Fax:
Mailing address:
  • Phone: 248-240-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801014046
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: