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General NPI Number Information
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NPI Number | 1407147077
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIRS VA ANN ARBOR HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 3333 GLENDALE AVE., TOLEDO OHIO 43614 HCHV PROGRAM VA TOLEDO CBOC
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City | TOLEDO
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State | OH
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Zip | 43614
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Country | US
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Telephone | 419-213-7663
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Fax | 419-724-4149
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Provider Business Mailing Address
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Address Line | 3333 GLENDALE AVE TOLEDO OHIO 43614 HCHV PROGRAM VA TOLEDO CBOC
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City | TOLEDO
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State | OH
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Zip | 43614
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Country | US
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Telephone | 419-213-7663
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Fax | 419-724-4149
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Authorized Official
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Title or Position | OUTREACH SOCIAL WORKER
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Name | MR. MICHAEL HOWARD NOVITSKI
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Credential | LISW-S
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Telephone | 419-213-7663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I0009959
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License Number State | OH
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