Healthcare Provider Details

I. General information

NPI: 1871864579
Provider Name (Legal Business Name): HOBERMAN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GRINDLEY PARK ST SUITE 3
DEARBORN MI
48124-2553
US

IV. Provider business mailing address

1800 GRINDLEY PARK ST SUITE 3
DEARBORN MI
48124-2553
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-1166
  • Fax: 313-277-3414
Mailing address:
  • Phone: 313-277-1166
  • Fax: 313-277-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6301002903
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6301002903
License Number StateMI

VIII. Authorized Official

Name: MR. MELVIN HOBERMAN
Title or Position: OWNER
Credential: MA, LLP, LCSW, CAAC
Phone: 313-277-1166