Active NPI
Mercedes Gough
- Clinical Social Worker
- Detroit, MI
National Provider Identifier
1073146700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6851110114
- Practice address
- 882 Oakman Blvd
Detroit, MI 48238-3710 - Phone
- (313) 961-4890
- NPI assigned
- Feb 21, 2020
- Last updated
- Dec 8, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6851110114 | MI | Primary |
Addresses
Primary practice location
882 Oakman Blvd
Detroit, MI 48238-3710
Mailing address
18241 Lister Ave
Eastpointe, MI 48021-2714
Phone (248) 520-4696
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851110114 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701993600000",
"number": "1073146700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18241 LISTER AVE",
"city": "EASTPOINTE",
"state": "MI",
"postal_code": "480212714",
"telephone_number": "248-520-4696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "882 OAKMAN BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482383710",
"telephone_number": "313-961-4890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGH",
"first_name": "MERCEDES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-21",
"last_updated": "2023-12-08",
"certification_date": "2023-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6851110114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.