Serena Eagan, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801091041 Issued in MI

Practice address

19401 Northline Rd
Southgate, MI 48195-2277

Phone

(734) 785-7718

NPI assigned

Jan 12, 2009

Last updated

Aug 4, 2022By the provider in NPPES

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

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Richard Kneip PHD PCGroup PAC ID 4880768415, 243 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Richard Kneip, PH.D., P.C.

  dba Great Lakes Psychology Group

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  Medicare reassignment Care Compare group NPD
• Henry Ford Health Eastwood Behavioral Health

  dba Eastwood Clinics

  • Social Worker
  • Clinton Township, MI
  • NPI 1396787701
  Medicare reassignment NPD

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

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1982841052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14057 BRADY",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482392820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19401 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952277",
            "telephone_number": "734-785-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAGAN",
        "first_name": "SERENA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-12",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801091041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Dusute
• Sarah Duxter
• Dva Healthcare Renal Care Inc (Southgate Dialysis)
• Tina Ann Dykehouse
• Theodore Joseph Dziengelewski
• Eagle Drugs Inc (Eagle Drugs pharmacy)
• East River Associates LLC (Sav- Mor #100)
• Larry Clinton Eaton, P.T.
• Bahae Mohammed Ebrahem
• Samantha Edmonds

• Social Worker in Southgate, MI
• Providers in Southgate, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.