Healthcare Provider Details

I. General information

NPI: 1801255989
Provider Name (Legal Business Name): TERRY GEFFEN-GOLD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

5040 MIRROR LAKE CT
WEST BLOOMFIELD MI
48323-1534
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5350
  • Fax:
Mailing address:
  • Phone: 248-738-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801062247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: