Provider Demographics
NPI:1164575577
Name:MCCRARY, JOSEPHINE A (LMSW, CAC-1)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:A
Last Name:MCCRARY
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 1:9851 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1424
Mailing Address - Country:US
Mailing Address - Phone:313-883-2341
Mailing Address - Fax:313-883-3957
Practice Address - Street 1:9851 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1424
Practice Address - Country:US
Practice Address - Phone:313-883-2341
Practice Address - Fax:313-883-3957
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010349631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical