Provider Demographics
NPI:1477643195
Name:KRAEMER, THOMAS RICHARD (LBSW/QMRP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RICHARD
Last Name:KRAEMER
Suffix:
Gender:M
Credentials:LBSW/QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W WALKER RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-8820
Mailing Address - Country:US
Mailing Address - Phone:810-648-3739
Mailing Address - Fax:
Practice Address - Street 1:190 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1009
Practice Address - Country:US
Practice Address - Phone:810-583-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802069143104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6802069143OtherSOCIAL WORKER LICENSE