MEDICARE: DEIRDRE ANNE KING 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	6801096429	MI

General Provider Information

NPI Number	:	1689037350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE ANNE KING LMSW

Provider Business Mailing Address
First Line	:	815 W MARSHALL ST
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-1609
Country	:	US
Telephone Number	:	313-974-2826
Fax Number	:

Provider Business Practice Location Address
First Line	:	17320 W 12 MILE RD
Second Line	:	SUITE 101
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-2100
Country	:	US
Telephone Number	:	802-671-5464
Fax Number	:

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	10/28/2024

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