Provider Demographics
NPI:1780262733
Name:KASSAB-GRAY, ANN (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:KASSAB-GRAY
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 1:1943 DEER PATH TRL
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1875
Mailing Address - Country:US
Mailing Address - Phone:248-787-1266
Mailing Address - Fax:
Practice Address - Street 1:1943 DEER PATH TRL
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-1875
Practice Address - Country:US
Practice Address - Phone:248-787-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801067099104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker