Healthcare Provider Details

I. General information

NPI: 1730686197
Provider Name (Legal Business Name): LAMBRO SEREMETIS LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 E. 12 MILE ROAD, STE. 200
WARREN MI
48093
US

IV. Provider business mailing address

533 GLEN ARBOR LN
GROSSE POINTE WOODS MI
48236-1506
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: