Healthcare Provider Details

I. General information

NPI: 1144793639
Provider Name (Legal Business Name): JOHN ALEXANDER-BLAIR RAMIREZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN ALEXANDER RAMIREZ

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 146TH AVE # 242
WEST OLIVE MI
49460-9673
US

IV. Provider business mailing address

8600 146TH AVE # 242
WEST OLIVE MI
49460-9673
US

V. Phone/Fax

Practice location:
  • Phone: 909-395-7004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118584
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74820
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-0205433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: