Provider Demographics
NPI:1285769018
Name:KANAAR, RALPH FENTON (LMSW)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:FENTON
Last Name:KANAAR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 E SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610-9646
Mailing Address - Country:US
Mailing Address - Phone:989-345-5259
Mailing Address - Fax:
Practice Address - Street 1:789 N CLARE AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9194
Practice Address - Country:US
Practice Address - Phone:989-539-2141
Practice Address - Fax:989-539-2143
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010100531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical