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General NPI Number Information
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NPI Number | 1982156980
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Entity Type | Organization
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Legal Business Name | MERIBETH GANDY PEZDA LLC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 959 BAKER RD SUITE 1A
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City | DEXTER
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State | MI
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Zip | 48130-1593
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Country | US
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Telephone | 734-757-3103
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Fax |
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Provider Business Mailing Address
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Address Line | 959 BAKER RD SUITE 1A
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City | DEXTER
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State | MI
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Zip | 48130-1593
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Country | US
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Telephone | 734-757-3103
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. MERIBETH GANDY PEZDA
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Credential | LMSA
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Telephone | 734-757-3103
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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 | 6801070819
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License Number State | MI
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