Healthcare Provider Details

I. General information

NPI: 1700888674
Provider Name (Legal Business Name): QUENTIN CALVERT CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD 132
SOUTHFIELD MI
48075-3710
US

IV. Provider business mailing address

25925 TELEGRAPH RD 210
SOUTHFIELD MI
48034-2518
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3301
  • Fax: 248-849-5378
Mailing address:
  • Phone: 248-746-0342
  • Fax: 248-746-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801017944
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: