Melanie C Driscoll, LLMSW

Key facts

NPI

1902391378

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

6801116258 (MI)

Practice address

5500 Auto Club Dr Ste 350
Dearborn, MI 48126-2779

Phone

(313) 217-2000

Fax

(313) 217-2090

NPI assigned

Jun 27, 2018

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 12, 2024.

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1902391378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18224 W 12 MILE RD APT 304",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762667",
            "telephone_number": "248-938-5162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 AUTO CLUB DR STE 350",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262779",
            "telephone_number": "313-217-2000",
            "fax_number": "313-217-2090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1777 Axtell Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480844400",
            "country_code": "US",
            "telephone_number": "248-613-5377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DRISCOLL",
        "first_name": "MELANIE",
        "middle_name": "C",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801116258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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