Healthcare Provider Details

I. General information

NPI: 1437235736
Provider Name (Legal Business Name): REGINA E. MCIVER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E. TWELVE ROAD
WARREN MI
48093-2405
US

IV. Provider business mailing address

4120 CASS AVE APT 1
DETROIT MI
48201-1705
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5872
  • Fax:
Mailing address:
  • Phone: 313-303-9847
  • Fax: 313-833-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801016982
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: