| Delaware Professional Therapy Pllc | |
|
116 W 8 Mile Rd Ste B Hazel Park MI 48030-2433 | |
| (313) 421-8366 | |
| Not Available |
| Full Name | Delaware Professional Therapy Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 116 W 8 Mile Rd Ste B, Hazel Park, Michigan |
| Authorized Official Name and Position | John Boyd Krisel (OWNER) |
| Authorized Official Contact | 3134218366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Delaware Professional Therapy Pllc 116 W 8 Mile Rd Ste B Hazel Park MI 48030-2433 Ph: (313) 421-8366 | Delaware Professional Therapy Pllc 116 W 8 Mile Rd Ste B Hazel Park MI 48030-2433 Ph: (313) 421-8366 |
| NPI Number | 1124496591 |
|---|---|
| Provider Enumeration Date | 09/02/2015 |
| Last Update Date | 09/02/2015 |
| Medicare PECOS PAC ID | 9931418118 |
|---|---|
| Medicare Enrollment ID | O20151029001458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124496591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 6801059788 (Michigan) | Primary |
| Provider Name | John B Krisel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437289071 PECOS PAC ID: 1456660638 Enrollment ID: I20151029001642 |
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