Healthcare Provider Details

I. General information

NPI: 1235139502
Provider Name (Legal Business Name): SUSAN BROWNE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KERCHEVAL AVE SUITE 305
GROSSE POINTE FARMS MI
48236-3629
US

IV. Provider business mailing address

131 KERCHEVAL AVE SUITE 305
GROSSE POINTE FARMS MI
48236-3629
US

V. Phone/Fax

Practice location:
  • Phone: 313-882-1430
  • Fax:
Mailing address:
  • Phone: 313-882-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801000712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: