Healthcare Provider Details

I. General information

NPI: 1629230545
Provider Name (Legal Business Name): CORINNE BEACH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORINNE ULRICH LLMSW

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25401 HARPER AVE
SAINT CLAIR SHORES MI
48081-2240
US

IV. Provider business mailing address

9844 DIXIE HWY
IRA MI
48023-2813
US

V. Phone/Fax

Practice location:
  • Phone: 586-466-6912
  • Fax:
Mailing address:
  • Phone: 586-716-7600
  • Fax: 586-716-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090394
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: