Provider Demographics
NPI:1942781695
Name:RAMIREZ, JUAN RICADO (LLMSW)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:RICADO
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 DELTA RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9340
Mailing Address - Country:US
Mailing Address - Phone:989-778-2272
Mailing Address - Fax:
Practice Address - Street 1:2355 DELTA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9340
Practice Address - Country:US
Practice Address - Phone:989-778-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1013430545103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013430545Medicaid