MEDICARE: MRS. LANETIA MARIE NORRIS LMSW, ACSW

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		MI

General Provider Information

NPI Number	:	1932325180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LANETIA MARIE NORRIS LMSW, ACSW

Provider Business Mailing Address
First Line	:	20592 WOODBINE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-4512
Country	:	US
Telephone Number	:	313-207-8000
Fax Number	:	313-354-8426

Provider Business Practice Location Address
First Line	:	20700 CIVIC CENTER DR
Second Line	:	SUITE 170
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-4140
Country	:	US
Telephone Number	:	313-207-8000
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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