=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033441282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACOMB COUNTY CMH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2010
-----------------------------------------------------
Last Update Date | 02/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46360 GRATIOT AVE
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48051-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-948-0226
-----------------------------------------------------
Fax | 586-948-0213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22550 HALL RD
-----------------------------------------------------
City | CLINTON TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48036-1189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-469-5769
-----------------------------------------------------
Fax | 586-469-7958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. NORMA JOSEF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 586-465-8322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------