Healthcare Provider Details

I. General information

NPI: 1346670403
Provider Name (Legal Business Name): SHRINA EADEH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37805 WINDWOOD DR
FARMINGTON HILLS MI
48335-2762
US

IV. Provider business mailing address

37805 WINDWOOD DR
FARMINGTON HILLS MI
48335-2762
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-5066
  • Fax:
Mailing address:
  • Phone: 248-910-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093798
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: