Provider Demographics
NPI:1508322983
Name:MRAZEK, AMY CRESENTIA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CRESENTIA
Last Name:MRAZEK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9337 BIG ROCK DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9308
Mailing Address - Country:US
Mailing Address - Phone:810-614-7065
Mailing Address - Fax:
Practice Address - Street 1:5250 LOVERS LN STE 200
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1579
Practice Address - Country:US
Practice Address - Phone:800-676-0423
Practice Address - Fax:269-441-1234
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103344104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker