Mina Tyleramanda Blatt, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801113677

Practice address

11480 E 13 Mile Rd
Warren, MI 48093-2566

Phone

(586) 216-9253

NPI assigned

May 20, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mina Bethel Former name

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

International Therapy Solutions PLLCGroup PAC ID 9739463084, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• International Therapy Solutions, PLLC

  • Clinical Social Worker
  • Warren, MI
  • NPI 1093254120
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1932766557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50258 VAN DYKE AVE",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483171374",
            "telephone_number": "586-884-4714",
            "fax_number": "586-884-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11480 E 13 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932566",
            "telephone_number": "586-216-9253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50258 Van Dyke Ave",
            "address_purpose": "LOCATION",
            "city": "Shelby Twp",
            "state": "MI",
            "postal_code": "483171374",
            "country_code": "US",
            "telephone_number": "586-884-4714",
            "fax_number": "586-884-4693",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLATT",
        "first_name": "MINA",
        "middle_name": "TYLERAMANDA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-20",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801104434",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "6801113677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MINA",
            "last_name": "BETHEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Majeed Francis Biya, DDS
• Autumn Bjornstad, MA, CCC-SLP
• Renisha Black
• Tristan Blanchette, DO
• Kristen Lynne Blankenship, MS, PT
• Blessed Angels Home Health Care, LLC
• Brianna Bletch
• Leah Beth Blinstrub, R.D.
• Elizabeth A Blomenberg, PA-C
• William S Bloom, DDS

• Clinical Social Worker in Warren, MI
• Providers in Warren, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.

Verify at the official NPI Registry.