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General NPI Number Information
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NPI Number | 1669113825
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Entity Type | Individual
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Provider Name | CHERYL DENISE GREEN LLMSW
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Gender | Female
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Dates
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Enumeration Date | 04/04/2022
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 26520 GRAND RIVER AVE STE 121
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City | REDFORD
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State | MI
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Zip | 48240-1506
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Country | US
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Telephone | 313-533-5652
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Fax | 313-533-5644
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Provider Business Mailing Address
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Address Line | 23450 BEVERLY ST # 523-9102
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City | OAK PARK
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State | MI
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Zip | 48237-1971
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Country | US
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Telephone | 313-523-9102
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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 | 6851109098
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License Number State | MI
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