Healthcare Provider Details

I. General information

NPI: 1184660508
Provider Name (Legal Business Name): HARDISH VERMA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SOUTH BLVD W STE 200
ROCHESTER HILLS MI
48307
US

IV. Provider business mailing address

2438 KINGSCROSS DR
SHELBY TOWNSHIP MI
48316-1250
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-6234
  • Fax: 248-844-6237
Mailing address:
  • Phone: 248-656-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801059177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: