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General NPI Number Information
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NPI Number | 1356514319
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Entity Type | Organization
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Legal Business Name | SAMARITAN CENTER OF SOUTHWEST MICHIGAN
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 1850 COLFAX AVE
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City | BENTON HARBOR
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State | MI
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Zip | 49022-6753
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Country | US
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Telephone | 269-926-6199
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Fax | 269-926-6780
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Provider Business Mailing Address
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Address Line | 1850 COLFAX AVE
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City | BENTON HARBOR
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State | MI
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Zip | 49022-6753
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Country | US
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Telephone | 269-926-6199
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Fax | 269-926-6780
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MS. JOSEPHINE C CASSAR
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Credential | LCSW
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Telephone | 269-926-6199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101005789
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801016920
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License Number State | MI
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