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General NPI Number Information
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NPI Number | 1295039667
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Entity Type | Individual
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Provider Name | CARA BRIANNE CLEVENGER LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 700 STEWART RD SUITE 105
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City | MONROE
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State | MI
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Zip | 48162-5304
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Country | US
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Telephone | 734-240-1765
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Fax | 734-240-1787
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Provider Business Mailing Address
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Address Line | 1078 FIRECREEK CT
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City | TEMPERANCE
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State | MI
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Zip | 48182-2227
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Country | US
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Telephone | 734-735-5992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801091088
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License Number State | MI
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