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NPI Code Detail

MEDICARE: MARCELLA BOLEN

MEDICARE: MARCELLA BOLEN
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1558833962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCELLA BOLEN
Provider Business Mailing Address
First Line : 2830 CHADWICK DR
Second Line :
City : WATERFORD
State : MI
Zip : 48328-3606
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14100 NEWBURGH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48154-5010
Country : US
Telephone Number : 734-464-7810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/24/2018
Last Update Date : 12/24/2018

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Directions to “ MARCELLA BOLEN ” Practice Location

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