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Individual provider Active NPI Clinical Social Worker · Brooklyn, MI

NPI 1033820600 · NPPES record last updated Dec 5, 2022

Key facts

NPI
1033820600
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
6851114632 (MI)
Practice address
119 Bingham Dr
Brooklyn, MI 49230-8926
Phone
(513) 693-0191
NPI assigned
Dec 5, 2022
Sex
Female
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

LicenseStateTypeSpecialty
6851114632MIMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6851114632 MI Yes

Addresses

Primary practice location

119 Bingham Dr
Brooklyn, MI 49230-8926

Mailing address

2728 Westmar CT Apt 506
Toledo, OH 43615-2093
Phone (513) 693-0191

Other providers in Brooklyn, MI

All providers in Brooklyn, MI · Clinical Social Worker in Michigan

Sources for this page

Verify at the official NPI Registry.