Active NPI
Delaware Professional Therapy PLLC
- Social Worker
- Hazel Park, MI
National Provider Identifier
1124496591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801059788
- Legal business name
- DELAWARE PROFESSIONAL THERAPY PLLC
- Practice address
- 116 W 8 Mile Rd Ste B
Hazel Park, MI 48030-2433 - Phone
- (313) 421-8366
- NPI assigned
- Sep 2, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Boyd Krisel Jr., MSW
- Title
- Owner
- Phone
- (313) 421-8366
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801059788 | MI | Primary |
Addresses
Primary practice location
116 W 8 Mile Rd Ste B
Hazel Park, MI 48030-2433
Mailing address
116 W 8 Mile Rd Ste B
Hazel Park, MI 48030-2433
Phone (313) 421-8366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151029001458 | MI | Part B Supplier - Clinic/Group Practice | 9931418118 |
Receives reassigned benefits from 1 practitioner Practice locations: Hazel Park, MI |
National Provider Directory
National Provider DirectoryLocations
116 W 8 Mile Rd
Ste B
Hazel Park, MI 48030
Phone (313) 421-8366
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441152000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1441152000000",
"number": "1124496591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 W 8 MILE RD STE B",
"city": "HAZEL PARK",
"state": "MI",
"postal_code": "480302433",
"telephone_number": "313-421-8366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 W 8 MILE RD STE B",
"city": "HAZEL PARK",
"state": "MI",
"postal_code": "480302433",
"telephone_number": "313-421-8366"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DELAWARE PROFESSIONAL THERAPY PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-09-02",
"last_updated": "2015-09-02",
"status": "A",
"authorized_official_last_name": "KRISEL",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "BOYD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "313-421-8366",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "MSW"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker",
"state": "MI",
"license": "6801059788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hazel Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.