Healthcare Provider Details

I. General information

NPI: 1275983280
Provider Name (Legal Business Name): JOSE CARRERA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W WILLOW ST
LANSING MI
48917-1833
US

IV. Provider business mailing address

2800 W WILLOW ST
LANSING MI
48917-1833
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-4734
  • Fax:
Mailing address:
  • Phone: 517-323-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069652
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: