Healthcare Provider Details

I. General information

NPI: 1710358619
Provider Name (Legal Business Name): ROSE MARIE DORE-GRACZYK SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50584 HELMANDALE ST
CHESTERFIELD MI
48047-3636
US

IV. Provider business mailing address

50584 HELMANDALE ST
CHESTERFIELD MI
48047-3636
US

V. Phone/Fax

Practice location:
  • Phone: 586-215-5729
  • Fax:
Mailing address:
  • Phone: 586-215-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801020248
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801020248
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: