Healthcare Provider Details

I. General information

NPI: 1710191846
Provider Name (Legal Business Name): MELISSA ALTOMARE L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 KERCHEVAL AVE
GROSSE POINTE FARMS MI
48236-3610
US

IV. Provider business mailing address

2111 VAN ANTWERP ST
GROSSE POINTE WOODS MI
48236-1624
US

V. Phone/Fax

Practice location:
  • Phone: 313-640-2537
  • Fax:
Mailing address:
  • Phone: 313-213-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801076906
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: