=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598297053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BART CATALFIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2017
-----------------------------------------------------
Last Update Date | 04/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 S HURON PKWY
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-677-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2424 PITTSFIELD BLVD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-677-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMSW
-----------------------------------------------------
Name | BART C CATALFIO
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 734-677-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801092433
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------