Provider Demographics
NPI:1407294002
Name:SENESI, PHYLLIS (LMSW, LMFT)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:SENESI
Suffix:
Gender:F
Credentials:LMSW, LMFT
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 19696
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49019-0696
Mailing Address - Country:US
Mailing Address - Phone:269-353-7607
Mailing Address - Fax:269-344-0453
Practice Address - Street 1:426 SOLON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4289
Practice Address - Country:US
Practice Address - Phone:269-353-7607
Practice Address - Fax:269-344-0453
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010161681041C0700X
MI4101005968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist