Healthcare Provider Details

I. General information

NPI: 1972410470
Provider Name (Legal Business Name): MARIE ELIZABETH MUSHRO LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHN R RD STE 110B
TROY MI
48083-4317
US

IV. Provider business mailing address

42296 LOCHMOOR ST
CLINTON TOWNSHIP MI
48038-1775
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-0678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: