Kenneth J Formosa Sr., MSW, LMSW
Individual provider Active NPI Social Worker · Roamulas, MI
NPI 1215947320 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215947320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 6801069917 (MI)
- Practice address
- Romulas Help Center
9430 Wayne Road Suite a
Roamulas, MI 48174 - Phone
- (734) 942-7585
- Fax
- (734) 942-7977
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801069917 | MI | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801069917 | MI | Yes |
Addresses
Primary practice location
Romulas Help Center
9430 Wayne Road Suite a
Roamulas, MI 48174
Mailing address
8416 Baytes Dr
Brighton, MI 48116
Phone (734) 751-5722
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.