Active NPI
Emily Otten
- Clinical Social Worker
- Waterford, MI
National Provider Identifier
1508317926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801092860
- Practice address
- 608 E Preda Dr
Waterford, MI 48328-2025 - Phone
- (248) 240-0546
- NPI assigned
- Oct 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | 6801092860 | MI | Primary |
Addresses
Primary practice location
608 E Preda Dr
Waterford, MI 48328-2025
Mailing address
608 E Preda Dr
Waterford, MI 48328-2025
Phone (248) 240-0546
Other names 1
- Emily Declerck
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2045 E W Maple Rd
Suite D405
Commerce Township, MI 48390-3801
Phone (248) 669-9500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801092860 | MI | MD | Clinical Social 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 and National Provider Directory roles.
-
- Clinical Psychologist
- Commerce TWP, MI
- NPI 1831641539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476921600000",
"number": "1508317926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "608 E PREDA DR",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483282025",
"telephone_number": "248-240-0546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 E PREDA DR",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483282025",
"telephone_number": "248-240-0546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTEN",
"first_name": "EMILY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-20",
"last_updated": "2016-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801092860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "EMILY",
"last_name": "DECLERCK",
"credential": "LMSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.