Healthcare Provider Details

I. General information

NPI: 1811834476
Provider Name (Legal Business Name): MYSTERY AND MANNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18518 OUTER DR
DEARBORN MI
48128-1874
US

IV. Provider business mailing address

18518 OUTER DR
DEARBORN MI
48128-1874
US

V. Phone/Fax

Practice location:
  • Phone: 734-407-7701
  • Fax: 313-722-4391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD R PENNISI
Title or Position: OWNER
Credential: LMSW-CLINICAL
Phone: 734-407-7701