Healthcare Provider Details

I. General information

NPI: 1396019592
Provider Name (Legal Business Name): CHERYL BOCHENEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 SILVER PKWY STE D
FENTON MI
48430-3468
US

IV. Provider business mailing address

17100 SILVER PKWY STE D
FENTON MI
48430-3468
US

V. Phone/Fax

Practice location:
  • Phone: 810-208-0378
  • Fax: 810-963-1917
Mailing address:
  • Phone: 810-208-0378
  • Fax: 810-963-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: