Individual provider Active NPI

Gemma Haynes, LMSW

  • Clinical Social Worker
  • Roseville, MI
National Provider Identifier
1033661285
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801103861 Issued in MI
Practice address
14 Mile Rd
Roseville, MI 48066
Phone
(586) 303-7843
Fax
(586) 415-6932
NPI assigned
Nov 3, 2016
Last updated
Aug 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801099584 MI
Clinical Social Worker 1041C0700X 6801103861 MI Primary

Addresses

Primary practice location

14 Mile Rd
Roseville, MI 48066

Mailing address

23231 Woodward Ave
Ferndale, MI 48220-1361

Other practice location 1

23231 Woodward Ave
Ferndale, MI 48220-1361
Phone (248) 581-8777

Other identifiers 1

IdentifierTypeStateIssuer
1033661285MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801099584MIMDSocial Worker

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1033661285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23231 WOODWARD AVE",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482201361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MILE RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "48066",
            "telephone_number": "586-303-7843",
            "fax_number": "586-415-6932"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23231 Woodward Ave",
            "address_purpose": "LOCATION",
            "city": "Ferndale",
            "state": "MI",
            "postal_code": "482201361",
            "country_code": "US",
            "telephone_number": "248-581-8777",
            "fax_number": "888-975-9374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "GEMMA",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-03",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801099584",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801103861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033661285",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.