Healthcare Provider Details

I. General information

NPI: 1154701555
Provider Name (Legal Business Name): KEVIN SCHWARTZ LBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

IV. Provider business mailing address

31511 CAMBRIDGE ST
GARDEN CITY MI
48135-1733
US

V. Phone/Fax

Practice location:
  • Phone: 734-722-4684
  • Fax: 734-467-7646
Mailing address:
  • Phone: 734-722-4684
  • Fax: 734-467-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802086742
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: