Healthcare Provider Details

I. General information

NPI: 1699691964
Provider Name (Legal Business Name): MAGGIE OBERMEYER LEISMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE CHRISTINE OBERMEYER

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-2304
US

IV. Provider business mailing address

405 E 6TH ST APT 2
ROYAL OAK MI
48067-2738
US

V. Phone/Fax

Practice location:
  • Phone: 248-865-4480
  • Fax:
Mailing address:
  • Phone: 616-914-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118663
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801118663
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801118663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: