=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730178534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN A CAIN-TORREZ LMSW ACSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2005
-----------------------------------------------------
Last Update Date | 12/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5705 W JOHNSON RD
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-425-4414
-----------------------------------------------------
Fax | 312-425-4434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5705 W JOHNSON RD
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-425-4414
-----------------------------------------------------
Fax | 231-425-4434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | KC057018
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------