Provider Demographics
NPI:1356360754
Name:KANFER, RACHEL ILENE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ILENE
Last Name:KANFER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:ILENE
Other - Last Name:ZAGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1129 W 14 MILE RD # 1014
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2801
Mailing Address - Country:US
Mailing Address - Phone:248-214-1100
Mailing Address - Fax:
Practice Address - Street 1:4502 GROVELAND AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1551
Practice Address - Country:US
Practice Address - Phone:248-214-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0775411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP12140037Medicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER