Provider Demographics
NPI:1295021061
Name:KASPEROWICZ, MICHELLE MARY (LLBSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARY
Last Name:KASPEROWICZ
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44899 CENTRE CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5510
Mailing Address - Country:US
Mailing Address - Phone:586-792-1654
Mailing Address - Fax:586-792-1656
Practice Address - Street 1:44899 CENTRE CT
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5510
Practice Address - Country:US
Practice Address - Phone:586-792-1654
Practice Address - Fax:586-792-1656
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086968104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker