MEDICARE: JANELLE RABBAN LLMSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6801106517	MI

General Provider Information

NPI Number	:	1578175857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE RABBAN LLMSW

Provider Business Mailing Address
First Line	:	12900 W CHICAGO ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2651
Country	:	US
Telephone Number	:	313-309-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 W CHICAGO ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2651
Country	:	US
Telephone Number	:	313-309-5900
Fax Number	:

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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