Healthcare Provider Details

I. General information

NPI: 1205975877
Provider Name (Legal Business Name): INGRID ZOMBOREANU BOETTCHER MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21885 DUNHAM RD. MCCMH - SRS STE 5
CLINTON TWP. MI
48036
US

IV. Provider business mailing address

35742 UNION LAKE RD
HARRISON TWP MI
48045-3178
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-6606
  • Fax: 586-469-6364
Mailing address:
  • Phone: 586-469-6606
  • Fax: 586-469-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801080115
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: