James Raymond Tumidanski
Individual provider Active NPI Social Worker · Vassar, MI
NPI 1578748786 · NPPES record last updated Jan 7, 2008
Key facts
- NPI
- 1578748786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 6802079385 (MI)
- Practice address
- 150 Enterprise Dr
Vassar, MI 48768-9584 - Phone
- (734) 564-4091
- NPI assigned
- Jan 7, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 200723 | MI | MD | Addiction (Substance Use Disorder) Counselor |
| S-00055 | MI | MD | Addiction (Substance Use Disorder) Counselor |
| 6802079385 | MI | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 200723 | MI | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | S-00055 | MI | |
| Social Worker | 104100000X | 6802079385 | MI | Yes |
Addresses
Primary practice location
150 Enterprise Dr
Vassar, MI 48768-9584
Mailing address
150 Enterprise Dr
Vassar, MI 48768-9584
Phone (734) 564-4091
Other providers in Vassar, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2008. 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.