Provider Demographics
NPI:1619221306
Name:KREFMAN-CASTELLON, RACHAEL ANNA (LMSW)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANNA
Last Name:KREFMAN-CASTELLON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ANNA
Other - Last Name:KREFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0854
Mailing Address - Country:US
Mailing Address - Phone:269-873-5966
Mailing Address - Fax:
Practice Address - Street 1:711 E GRAND RIVER AVE STE A
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2474
Practice Address - Country:US
Practice Address - Phone:269-873-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092018104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker