Provider Demographics
NPI:1093089617
Name:KRUMAN, LISA M (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KRUMAN
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 BORDEAUX ST
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3014
Mailing Address - Country:US
Mailing Address - Phone:248-684-4919
Mailing Address - Fax:
Practice Address - Street 1:6022 W MAPLE RD STE 403
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-684-4919
Practice Address - Fax:248-684-4919
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010652471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical