Provider Demographics
NPI:1639462302
Name:REDMOND, ANTHONY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:REDMOND
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24801 5 MILE RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3655
Mailing Address - Country:US
Mailing Address - Phone:313-225-2650
Mailing Address - Fax:313-592-1864
Practice Address - Street 1:24801 5 MILE RD
Practice Address - Street 2:SUITE 20
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3655
Practice Address - Country:US
Practice Address - Phone:313-225-2650
Practice Address - Fax:313-592-1864
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083821101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical