Healthcare Provider Details

I. General information

NPI: 1699552653
Provider Name (Legal Business Name): TATJANA RIBEIRO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6390 HAWTHORNE AVE
YPSILANTI MI
48197-3605
US

IV. Provider business mailing address

6390 HAWTHORNE AVE
YPSILANTI MI
48197-3605
US

V. Phone/Fax

Practice location:
  • Phone: 734-291-2607
  • Fax:
Mailing address:
  • Phone: 734-291-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680112282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: