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General NPI Number Information
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NPI Number | 1497839674
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Entity Type | Individual
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Provider Name | CONNIE CALDERON KRETSCHMER LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 580 FOREST AVE STE 4B
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City | PLYMOUTH
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State | MI
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Zip | 48170-1780
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Country | US
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Telephone | 810-923-8141
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Fax |
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Provider Business Mailing Address
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Address Line | 42154 SUTTERS LN
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City | NORTHVILLE
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State | MI
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Zip | 48168-3606
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Country | US
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Telephone | 810-923-8141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801070612
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License Number State | MI
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