Provider Demographics
NPI:1831101930
Name:KARAGON, JAMES J (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:KARAGON
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:PO BOX 441675
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-1675
Mailing Address - Country:US
Mailing Address - Phone:313-962-4075
Mailing Address - Fax:
Practice Address - Street 1:555 BRUSH ST
Practice Address - Street 2:2406
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4348
Practice Address - Country:US
Practice Address - Phone:313-962-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010078761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP21940Medicare ID - Type Unspecified
R67832Medicare UPIN