Healthcare Provider Details

I. General information

NPI: 1528114097
Provider Name (Legal Business Name): ROSEMARY MAZUREK ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N OLD WOODWARD AVE SUITE 300
BIRMINGHAM MI
48009-1322
US

IV. Provider business mailing address

700 N OLD WOODWARD AVE SUITE 300
BIRMINGHAM MI
48009-1322
US

V. Phone/Fax

Practice location:
  • Phone: 248-882-8636
  • Fax: 248-642-6832
Mailing address:
  • Phone: 248-882-8636
  • Fax: 248-642-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: