Healthcare Provider Details

I. General information

NPI: 1912102435
Provider Name (Legal Business Name): ALAN H ABLITZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28336 FRANKLIN RD
SOUTHFIELD MI
48034-5503
US

IV. Provider business mailing address

1308 S MAIN ST
PLYMOUTH MI
48170-2253
US

V. Phone/Fax

Practice location:
  • Phone: 248-357-3347
  • Fax:
Mailing address:
  • Phone: 734-451-3440
  • Fax: 734-927-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801000001
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: