Provider Demographics
NPI:1093484271
Name:KUZMICZ, RAELYNN (LLMSW)
Entity Type:Individual
Prefix:
First Name:RAELYNN
Middle Name:
Last Name:KUZMICZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:RAELYNN
Other - Middle Name:
Other - Last Name:ANTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1469 BENNING AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2403
Mailing Address - Country:US
Mailing Address - Phone:616-648-2764
Mailing Address - Fax:
Practice Address - Street 1:1115 BALL AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-456-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851107357104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker