Provider Demographics
NPI:1497839674
Name:KRETSCHMER, CONNIE CALDERON (LMSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:CALDERON
Last Name:KRETSCHMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42154 SUTTERS LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3606
Mailing Address - Country:US
Mailing Address - Phone:810-923-8141
Mailing Address - Fax:
Practice Address - Street 1:580 FOREST AVE STE 4B
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1780
Practice Address - Country:US
Practice Address - Phone:810-923-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010706121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical