Provider Demographics
NPI:1750348264
Name:RAKOCZY, KEVIN MICHAEL (MSW, ACSW, LMSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:RAKOCZY
Suffix:
Gender:M
Credentials:MSW, ACSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 22ND ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6308
Mailing Address - Country:US
Mailing Address - Phone:734-846-7620
Mailing Address - Fax:
Practice Address - Street 1:3922 22ND ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6308
Practice Address - Country:US
Practice Address - Phone:734-846-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0891768Medicare UPIN
MIP00134462Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI0N66300Medicare ID - Type UnspecifiedPROVIDER ID#