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General NPI Number Information
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NPI Number | 1376053330
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Entity Type | Individual
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Provider Name | JESSICA MICHELLE GORAS LLMSW
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Gender | Female
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 26300 OUTER DR
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City | LINCOLN PARK
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State | MI
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Zip | 48146-2019
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Country | US
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Telephone | 313-388-4630
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Fax |
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Provider Business Mailing Address
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Address Line | 503 N GAINSBOROUGH AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-4221
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Country | US
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Telephone | 517-677-6370
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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