Provider Demographics
NPI:1689872913
Name:HANNAFIUS, MITCHELL B (LMSW)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:B
Last Name:HANNAFIUS
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 1:2415 BURTON RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-9203
Mailing Address - Country:US
Mailing Address - Phone:269-591-2360
Mailing Address - Fax:
Practice Address - Street 1:261 M 62
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-1034
Practice Address - Country:US
Practice Address - Phone:269-445-3874
Practice Address - Fax:269-445-2076
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010894661041C0700X
IN33004521A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical