=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396519765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOMENTUM THERAPY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2023
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23650 WOODWARD AVE STE 201
-----------------------------------------------------
City | PLEASANT RIDGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48069-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-733-5797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23650 WOODWARD AVE STE 201
-----------------------------------------------------
City | PLEASANT RIDGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48069-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-733-5797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARNI D ALEKMAN
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 248-733-5797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------