MEDICARE: QUENTIN CALVERT 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	6801017944	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5301002923	OTHER	MI	LLP

General Provider Information

NPI Number	:	1700888674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUENTIN CALVERT CSW

Provider Business Mailing Address
First Line	:	25925 TELEGRAPH RD
Second Line	:	210
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-2518
Country	:	US
Telephone Number	:	248-746-0342
Fax Number	:	248-746-0308

Provider Business Practice Location Address
First Line	:	22255 GREENFIELD RD
Second Line	:	132
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-3710
Country	:	US
Telephone Number	:	248-849-3301
Fax Number	:	248-849-5378

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/22/2021

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Directions to “ QUENTIN CALVERT CSW” Practice Location

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