Healthcare Provider Details

I. General information

NPI: 1881264125
Provider Name (Legal Business Name): JULLIETTE M MAHFOUZ LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19853 OUTER DR STE 110
DEARBORN MI
48124-2044
US

IV. Provider business mailing address

2200 N CANTON CENTER RD STE 200A
CANTON MI
48187-5038
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-5056
  • Fax: 248-712-4381
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: