Provider Demographics
NPI:1093092868
Name:RANDAZZO-RATLIFF, MARIGRACE (MSW, LMSW, LLC)
Entity Type:Individual
Prefix:MRS
First Name:MARIGRACE
Middle Name:
Last Name:RANDAZZO-RATLIFF
Suffix:
Gender:F
Credentials:MSW, LMSW, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 W. ANN ARBOR TRAIL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:734-416-8818
Mailing Address - Fax:
Practice Address - Street 1:496 W. ANN ARBOR TRAIL
Practice Address - Street 2:SUITE 106
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-416-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010622071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical