MEDICARE: MS. KALA RENEE RICHARDS LLMSW

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
1	104100000X	Social Worker	6801090146	MI

General Provider Information

NPI Number	:	1376709048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KALA RENEE RICHARDS LLMSW

Provider Business Mailing Address
First Line	:	44899 CENTRE CT
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5510
Country	:	US
Telephone Number	:	586-792-1654
Fax Number	:	586-792-1656

Provider Business Practice Location Address
First Line	:	44899 CENTRE CT
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5510
Country	:	US
Telephone Number	:	586-792-1654
Fax Number	:	586-792-1656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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