Healthcare Provider Details

I. General information

NPI: 1558734624
Provider Name (Legal Business Name): THERESA BREYER LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 E 13 MILE RD # 300
WARREN MI
48093-5000
US

IV. Provider business mailing address

12220 E 13 MILE RD # 300
WARREN MI
48093-5000
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-1810
  • Fax:
Mailing address:
  • Phone: 586-573-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: