Provider Demographics
NPI:1396244364
Name:RASTIGUE, KERRY (LMSW)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:RASTIGUE
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:GREENBUSH
Mailing Address - State:MI
Mailing Address - Zip Code:48738-0187
Mailing Address - Country:US
Mailing Address - Phone:586-201-9507
Mailing Address - Fax:
Practice Address - Street 1:2171 S US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:GREENBUSH
Practice Address - State:MI
Practice Address - Zip Code:48738-9755
Practice Address - Country:US
Practice Address - Phone:506-201-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099290791041C0700X
OHI.24054041041C0700X
MI6801116063104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical