Healthcare Provider Details

I. General information

NPI: 1104017615
Provider Name (Legal Business Name): MOHAMMAD YAMIN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD STE 311
DEARBORN MI
48124-5031
US

IV. Provider business mailing address

15745 WAYNE ROAD
WESTLAND MI
48186
US

V. Phone/Fax

Practice location:
  • Phone: 313-271-8170
  • Fax: 313-271-8353
Mailing address:
  • Phone: 734-729-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801071394
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: