Healthcare Provider Details

I. General information

NPI: 1861743312
Provider Name (Legal Business Name): CATHERINE SEWICK LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 W 12 MILE RD STE 1
SOUTHFIELD MI
48076-2115
US

IV. Provider business mailing address

50641 DRAKES BAY DR
NOVI MI
48374-2548
US

V. Phone/Fax

Practice location:
  • Phone: 248-443-1995
  • Fax: 248-443-5573
Mailing address:
  • Phone: 248-361-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093869
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: