Healthcare Provider Details

I. General information

NPI: 1134059595
Provider Name (Legal Business Name): LAURA MAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 W BIG BEAVER RD STE 230
TROY MI
48084-2903
US

IV. Provider business mailing address

3290 W BIG BEAVER RD STE 230
TROY MI
48084-2903
US

V. Phone/Fax

Practice location:
  • Phone: 248-238-8702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851121717
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: