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General NPI Number Information
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NPI Number | 1619600996
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Entity Type | Individual
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Provider Name | CAMERON ROBEN MCCOY LLMSW
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Gender | Male
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 2750 CARPENTER RD STE 5
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City | ANN ARBOR
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State | MI
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Zip | 48108-1170
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Country | US
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Telephone | 586-585-6061
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Fax |
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Provider Business Mailing Address
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Address Line | 30602 OAKRIDGE MANOR DR
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City | ROSEVILLE
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State | MI
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Zip | 48066-7738
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Country | US
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Telephone | 586-585-6061
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851103400
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License Number State | MI
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