Provider Demographics
NPI:1548463094
Name:TRAGER, BARBARA ROSE (LMSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ROSE
Last Name:TRAGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E LAFAYETTE ST
Mailing Address - Street 2:#2007
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2905
Mailing Address - Country:US
Mailing Address - Phone:313-259-2419
Mailing Address - Fax:
Practice Address - Street 1:48561 ALPHA DR
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3442
Practice Address - Country:US
Practice Address - Phone:248-697-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010343661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical