Healthcare Provider Details

I. General information

NPI: 1184401754
Provider Name (Legal Business Name): DESIREE BERNADETTE ZINEVICH LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17251 W 12 MILE RD STE 200
SOUTHFIELD MI
48076-2140
US

IV. Provider business mailing address

15600 19 MILE RD
CLINTON TOWNSHIP MI
48038-3502
US

V. Phone/Fax

Practice location:
  • Phone: 248-406-6520
  • Fax:
Mailing address:
  • Phone: 586-263-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: