Active NPI
Melissa Hallock
- Social Worker
- Detroit, MI
National Provider Identifier
1134585755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802088802
- Practice address
- 4700 Beaufait St
Detroit, MI 48207-1372 - Phone
- (313) 267-9777
- Fax
- (313) 921-9131
- NPI assigned
- Jan 12, 2016
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802088802 | MI | Primary |
Addresses
Primary practice location
4700 Beaufait St
Detroit, MI 48207-1372
Mailing address
4700 Beaufait St
Detroit, MI 48207-1372
Phone (313) 267-9777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6802088802 | Other | MI | STATE OF MICHIGAN LIMITED LICENSE, BOARD OF SOCIAL WORK |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802088802 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Services to Enhance Potential | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Case Management Agency
- Detroit, MI
- NPI 1962884080
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452556800000",
"number": "1134585755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 BEAUFAIT ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482071372",
"telephone_number": "313-267-9777",
"fax_number": "313-921-9131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 BEAUFAIT ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482071372",
"telephone_number": "313-267-9777",
"fax_number": "313-921-9131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLOCK",
"first_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-12",
"last_updated": "2016-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802088802",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MICHIGAN LIMITED LICENSE, BOARD OF SOCIAL WORK",
"identifier": "6802088802",
"state": "MI"
}
],
"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 Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.