Healthcare Provider Details

I. General information

NPI: 1548785702
Provider Name (Legal Business Name): MARY LAFRAMBOISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 E BELTLINE AVE NE STE A
GRAND RAPIDS MI
49525-7045
US

IV. Provider business mailing address

21833 CUTLER RD
HOWARD CITY MI
49329-9307
US

V. Phone/Fax

Practice location:
  • Phone: 616-439-1135
  • Fax:
Mailing address:
  • Phone: 616-240-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARY LAFRAMBOISE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 616-439-1135