Provider Demographics
NPI:1598930521
Name:MUNIKRISHNA, PALLAVI
Entity Type:Individual
Prefix:MS
First Name:PALLAVI
Middle Name:
Last Name:MUNIKRISHNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 RIDGEVIEW CT APT 2206
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2787
Mailing Address - Country:US
Mailing Address - Phone:248-622-3209
Mailing Address - Fax:
Practice Address - Street 1:4321 E MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1720
Practice Address - Country:US
Practice Address - Phone:313-369-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63010120071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical