Provider Demographics
NPI:1023161064
Name:PENFIELD, RONALD B (MSW)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:PENFIELD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD
Mailing Address - Street 2:STE 143
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0435
Mailing Address - Country:US
Mailing Address - Phone:517-853-2992
Mailing Address - Fax:517-853-2993
Practice Address - Street 1:4990 NORTHWIND DR
Practice Address - Street 2:SUITE 240
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5090
Practice Address - Country:US
Practice Address - Phone:517-853-2992
Practice Address - Fax:517-853-2993
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801004048104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008940080OtherINDIVIDUAL BCBS PIN #
MIM77610001Medicare ID - Type Unspecified
MI8008940080OtherINDIVIDUAL BCBS PIN #