Healthcare Provider Details

I. General information

NPI: 1932778701
Provider Name (Legal Business Name): MS. MOLLY PATRICIA BUGAMELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36401 HARPER AVE
CLINTON TOWNSHIP MI
48035-2957
US

IV. Provider business mailing address

39323 COLUMBIA ST
HARRISON TOWNSHIP MI
48045-1745
US

V. Phone/Fax

Practice location:
  • Phone: 586-649-7589
  • Fax:
Mailing address:
  • Phone: 586-292-6977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801034380
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: