Healthcare Provider Details

I. General information

NPI: 1326699752
Provider Name (Legal Business Name): CARMENSITA J BUENTELLO LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 MICHIGAN AVE
DETROIT MI
48210-3039
US

IV. Provider business mailing address

5716 MICHIGAN AVE
DETROIT MI
48210-3039
US

V. Phone/Fax

Practice location:
  • Phone: 313-481-3137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801105765
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: