Provider Demographics
NPI:1528612538
Name:REDNAM-WALDO, SARATH PRIYA (LMSW)
Entity type:Individual
Prefix:
First Name:SARATH
Middle Name:PRIYA
Last Name:REDNAM-WALDO
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 1:18925 OAK DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2263
Mailing Address - Country:US
Mailing Address - Phone:314-805-4188
Mailing Address - Fax:
Practice Address - Street 1:18925 OAK DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2263
Practice Address - Country:US
Practice Address - Phone:314-805-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011040391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical