MEDICARE: MS. STEFANI ELIZABETH GOERLICH LMSW

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	104100000X	Social Worker	6801098058	MI

General Provider Information

NPI Number	:	1538657036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEFANI ELIZABETH GOERLICH LMSW

Provider Business Mailing Address
First Line	:	7007 METROPOLITAN PKWY UNIT 1329
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48311-7207
Country	:	US
Telephone Number	:	313-626-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 FRANKLIN PARK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2477
Country	:	US
Telephone Number	:	313-626-0160
Fax Number	:

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	05/30/2024

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