Healthcare Provider Details

I. General information

NPI: 1629984877
Provider Name (Legal Business Name): MERIDITH JOY CERVENAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LIVERNOIS RD
TROY MI
48098-4777
US

IV. Provider business mailing address

3407 ROCKHAVEN AVE
ROCHESTER HILLS MI
48309-4050
US

V. Phone/Fax

Practice location:
  • Phone: 248-823-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801089714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: