Healthcare Provider Details

I. General information

NPI: 1982995189
Provider Name (Legal Business Name): LORI BETH BLUMENSTEIN-BOTT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6474 PINECROFT DR
WEST BLOOMFIELD MI
48322-2245
US

IV. Provider business mailing address

6474 PINECROFT DR
WEST BLOOMFIELD MI
48322-2245
US

V. Phone/Fax

Practice location:
  • Phone: 248-568-0354
  • Fax:
Mailing address:
  • Phone: 248-538-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801021179
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: