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General NPI Number Information
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NPI Number | 1629299953
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Entity Type | Individual
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Provider Name | MICHAL SAMUEL MSW MA
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 1945 PAULINE BLVD STE 14
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City | ANN ARBOR
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State | MI
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Zip | 48103-5047
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Country | US
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Telephone | 734-926-9169
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Fax | 734-348-9905
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Provider Business Mailing Address
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Address Line | 1524 DICKEN DR
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City | ANN ARBOR
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State | MI
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Zip | 48103-4419
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Country | US
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Telephone | 734-926-9169
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Fax | 734-348-9005
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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 | 6301012583
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301012583
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License Number State | MI
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