Healthcare Provider Details

I. General information

NPI: 1831794130
Provider Name (Legal Business Name): MERCEDES L HUMBERT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERCEDES L HUMBERT LMSW

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GREENFIELD RD STE 300
DEARBORN MI
48120-1805
US

IV. Provider business mailing address

2100 N MAIN ST STE 304
CROWN POINT IN
46307-1877
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 574-546-1900
  • Fax: 574-546-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801111005
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: