Healthcare Provider Details

I. General information

NPI: 1093153892
Provider Name (Legal Business Name): MRS. MARIE C BRANCHEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE C SPERRY

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER PLACE DR STE 250
DETROIT MI
48207-5402
US

IV. Provider business mailing address

8245 FORREST DR
CANTON MI
48187-4205
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-2337
  • Fax:
Mailing address:
  • Phone: 313-570-4954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802085010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: