Provider Demographics
NPI:1255398632
Name:NAGAJ, AMY LYNNE (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:NAGAJ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2988
Mailing Address - Country:US
Mailing Address - Phone:517-474-4673
Mailing Address - Fax:
Practice Address - Street 1:2427 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2988
Practice Address - Country:US
Practice Address - Phone:517-474-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801080214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM12270053Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL