1265784011 NPI number — MRS. ANGELAH DAWN CRAMER LMSW, CAADC, CCS

Table of content: MRS. ANGELAH DAWN CRAMER LMSW, CAADC, CCS (NPI 1265784011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265784011 NPI number — MRS. ANGELAH DAWN CRAMER LMSW, CAADC, CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAMER
Provider First Name:
ANGELAH
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, CAADC, CCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOMEZ
Provider Other First Name:
ANGELAH
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW, CAADC, CCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265784011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 533
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48101-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7445 ALLEN RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48101-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-914-4085
Provider Business Practice Location Address Fax Number:
313-879-6549
Provider Enumeration Date:
10/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801093205 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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