Provider Demographics
NPI:1215590732
Name:SARNACKI, JEFFREY (LMSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SARNACKI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LAFAYETTE AVE SE STE 410
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4693
Mailing Address - Country:US
Mailing Address - Phone:616-685-8200
Mailing Address - Fax:616-685-8202
Practice Address - Street 1:310 LAFAYETTE AVE SE STE 410
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-685-8200
Practice Address - Fax:616-685-8202
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095953104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker