Provider Demographics
NPI:1609102938
Name:NAITO, MISAKI (MSW)
Entity Type:Individual
Prefix:MS
First Name:MISAKI
Middle Name:
Last Name:NAITO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3418
Mailing Address - Country:US
Mailing Address - Phone:269-968-2811
Mailing Address - Fax:269-968-2651
Practice Address - Street 1:151 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3418
Practice Address - Country:US
Practice Address - Phone:269-968-2811
Practice Address - Fax:269-968-2651
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010915791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883502Medicaid