MEDICARE: BLAKE ANGOVE CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801019252	MI

General Provider Information

NPI Number	:	1326040262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE ANGOVE CSW

Provider Business Mailing Address
First Line	:	538 S CHOCOLAY AVE
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-1811
Country	:	US
Telephone Number	:	248-435-8133
Fax Number	:

Provider Business Practice Location Address
First Line	:	6773 W MAPLE RD
Second Line	:	MAPLEGROVE CENTER
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3013
Country	:	US
Telephone Number	:	248-661-6535
Fax Number	:	248-661-6165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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