Kenneth Bruce Randolph LMSW,CSW

NPI 1770728388 - Social Worker - 1041C0700X

NPI Details
NPI 1770728388
Gender Male
Enumeration Date 12/10/2008
Last Updated 12/10/2008
Entity Type Individual
Active Over 7 years ago
Practice Location
29260 FRANKLIN RD STE 120
SOUTHFIELD MI, 48034-1196, US
Phone (248) 355-4300
Fax (248) 355-4393
Business Location
23531 WILDWOOD ST
DETROIT MI, 48237-2485, US
Phone (248) 968-0278
Fax
Toxanomy
Taxonomy Code 1041C0700X
License State Michigan
License Number 6801079851
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According to our database, Kenneth Bruce Randolph LMSW,CSW NPI is 1770728388, taxonomy code is 1041C0700X and license number is 6801079851, license state is located at Michigan. Kenneth Bruce Randolph LMSW,CSW physically located at 29260 Franklin Rd Ste 120, Southfield MI, 48034-1196. NPI Number Kenneth Bruce Randolph LMSW,CSW has the Individual type.

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1770728388 NPI number is provided on an as is basis without warranty of any kind. 1770728388 is maintained by the National Plan & Provider Enumeration System. The contents of Kenneth Bruce Randolph LMSW,CSW are for informational purposes only.