Healthcare Provider Details

I. General information

NPI: 1962975631
Provider Name (Legal Business Name): EMMA JEAN URBAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2019
Last Update Date: 01/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 MICHIGAN AVE
DETROIT MI
48210-3039
US

IV. Provider business mailing address

3552 PHEASANT RUN CIR APT 4
ANN ARBOR MI
48108-2469
US

V. Phone/Fax

Practice location:
  • Phone: 313-625-1336
  • Fax:
Mailing address:
  • Phone: 517-358-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: