=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528537917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE ANN MACOMBER PHD, LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2018
-----------------------------------------------------
Last Update Date | 11/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 863 N PINE RD STE A
-----------------------------------------------------
City | ESSEXVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48732-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-928-3566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7400 BAY RD H245
-----------------------------------------------------
City | UNIVERSITY CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48710-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-964-7136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6801086088
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------