=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710191846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA ALTOMARE L.M.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 159 KERCHEVAL AVE
-----------------------------------------------------
City | GROSSE POINTE FARMS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48236-3610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-640-2537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2111 VAN ANTWERP ST
-----------------------------------------------------
City | GROSSE POINTE WOODS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48236-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-213-8505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801076906
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------