Provider Demographics
NPI:1871191957
Name:DICESARE, KATRINA M (MSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:DICESARE
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 1:39340 MEDALLION CT APT 7103
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-4913
Mailing Address - Country:US
Mailing Address - Phone:616-322-5427
Mailing Address - Fax:
Practice Address - Street 1:39340 MEDALLION CT APT 7103
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-4913
Practice Address - Country:US
Practice Address - Phone:616-322-5427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator