Provider Demographics
NPI:1164434866
Name:LONDON-KRAMP, LISA ANN (BSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:LONDON-KRAMP
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3847 PINE GROVE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4265
Mailing Address - Country:US
Mailing Address - Phone:810-966-3732
Mailing Address - Fax:
Practice Address - Street 1:3847 PINE GROVE AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4265
Practice Address - Country:US
Practice Address - Phone:810-966-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802067232104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker