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NPI Code Detail

MEDICARE: MR. CHARLES EDWARD SALIS SR. LMSW

MEDICARE: MR. CHARLES EDWARD SALIS SR. 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
11041C0700XClinical Social Worker6801080040MI

General Provider Information

NPI Number : 1912217019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES EDWARD SALIS SR. LMSW
Provider Business Mailing Address
First Line : 3129 E LARNED ST
Second Line :
City : DETROIT
State : MI
Zip : 48207-3910
Country : US
Telephone Number : 313-567-0431
Fax Number :
Provider Business Practice Location Address
First Line : 2051 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48208-1105
Country : US
Telephone Number : 313-961-5057
Fax Number : 313-961-3405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2010
Last Update Date : 03/15/2026

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