Healthcare Provider Details

I. General information

NPI: 1659008506
Provider Name (Legal Business Name): DAYANARI CIFUENTES LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date: 08/22/2023
Reactivation Date: 08/31/2023

III. Provider practice location address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

IV. Provider business mailing address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2110
  • Fax: 616-942-0589
Mailing address:
  • Phone: 616-942-2110
  • Fax: 616-942-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: