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NPI Code Detail

MEDICARE: MRS. JANINE DANIELLE KITZMAN M.S.W., L.C.S.W.

MEDICARE: MRS. JANINE DANIELLE KITZMAN M.S.W., L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801066153MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16801066153OTHERMISTATE LICENSE

General Provider Information

NPI Number : 1053425058
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JANINE DANIELLE KITZMAN M.S.W., L.C.S.W.
Provider Business Mailing Address
First Line : 2019 RAMBLING RD
Second Line :
City : KALAMAZOO
State : MI
Zip : 49008-1630
Country : US
Telephone Number : 269-345-0909
Fax Number : 269-345-4985
Provider Business Practice Location Address
First Line : 2019 RAMBLING RD
Second Line :
City : KALAMAZOO
State : MI
Zip : 49008-1630
Country : US
Telephone Number : 269-345-0909
Fax Number : 269-345-4985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 07/08/2007

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