=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790469922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN MCCARREN LLMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2023
-----------------------------------------------------
Last Update Date | 06/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 KERCHEVAL AVE STE C&D
-----------------------------------------------------
City | GROSSE POINTE FARMS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48236-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-631-3489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 FONTANA LN
-----------------------------------------------------
City | GROSSE POINTE SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48236-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-400-4127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6851116555
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------