Healthcare Provider Details

I. General information

NPI: 1659324978
Provider Name (Legal Business Name): CAROL L MAST MSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BEVIER ST
SHELBY MI
49455-1209
US

IV. Provider business mailing address

71 BEVIER ST
SHELBY MI
49455-1209
US

V. Phone/Fax

Practice location:
  • Phone: 231-861-2187
  • Fax: 231-861-5100
Mailing address:
  • Phone: 231-861-2187
  • Fax: 231-861-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801071977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: