NPIMap

Organization Active NPI

Kristin M Melotik PLC

Doing business as Kristin Marie Periard MSW, LMSW

  • Clinical Social Worker
  • Northville, MI
National Provider Identifier
1902974231
Registry record updated Oct 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801067292 Issued in MI
Legal business name
KRISTIN M MELOTIK PLC
Doing business as
Kristin Marie Periard MSW, LMSW
Practice address
120 West Main St
Ste 202
Northville, MI 48167
Phone
(248) 347-6110
Fax
(248) 347-1120
NPI assigned
Dec 4, 2006
Last updated
Oct 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Kristin Marie Periard, MSW LMSWNPI 1073541082
Title
Agent Psychotherapist
Phone
(248) 347-6110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801067292 MI Primary

Addresses

Primary practice location

120 West Main St
Ste 202
Northville, MI 48167

Mailing address

120 West Main St
Ste 202
Northville, MI 48167
Phone (248) 347-6110

Other names 1

  • Kristin Marie Periard MSW, LMSW Doing business as

National Provider Directory

National Provider Directory

Locations

120 W Main St
Ste 202
Northville, MI 48167
Phone (248) 347-6110

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255392000000",
    "number": "1902974231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 WEST MAIN ST",
            "address_2": "STE 202",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "48167",
            "telephone_number": "248-347-6110",
            "fax_number": "248-347-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 WEST MAIN ST",
            "address_2": "STE 202",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "48167",
            "telephone_number": "248-347-6110",
            "fax_number": "248-347-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTIN M MELOTIK PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2009-10-13",
        "status": "A",
        "authorized_official_last_name": "PERIARD",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "AGENT PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "248-347-6110",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801067292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kristin Marie Periard MSW, LMSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Northville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.