=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073615050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEVERLY J. FLOYD ROWELL MSW IN SOCIAL WORK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4646 JOHN R ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-576-1000
-----------------------------------------------------
Fax | 313-576-1195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15064 WARWICK ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48223-2272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-378-1937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801072983
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------