Provider Demographics
NPI:1043380025
Name:RADAMIS, KATHRYN C (LMSW CAC-1)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:C
Last Name:RADAMIS
Suffix:
Gender:F
Credentials:LMSW CAC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 S. MERRIMAN RD.
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4951
Mailing Address - Country:US
Mailing Address - Phone:734-641-1141
Mailing Address - Fax:734-641-1142
Practice Address - Street 1:917 S MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4951
Practice Address - Country:US
Practice Address - Phone:734-641-1141
Practice Address - Fax:734-641-1142
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010880441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical