Provider Demographics
NPI:1720236664
Name:DIMEGLIO, KATHRYN CRANSTON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:CRANSTON
Last Name:DIMEGLIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:CRANSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:14194 CARDWELL ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4652
Mailing Address - Country:US
Mailing Address - Phone:248-704-0172
Mailing Address - Fax:
Practice Address - Street 1:14194 CARDWELL ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4652
Practice Address - Country:US
Practice Address - Phone:248-704-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490104601041C0700X
MI68010923831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical