MEDICARE: MRS. ALECIA CAREY BSW,LMSW,QMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801088366	MI

General Provider Information

NPI Number	:	1033595608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALECIA CAREY BSW,LMSW,QMHP

Provider Business Mailing Address
First Line	:	5470 CHENE ST
Second Line	:	SUITE 200
City	:	DETROIT
State	:	MI
Zip	:	48211-2746
Country	:	US
Telephone Number	:	313-976-5320
Fax Number	:	313-579-0610

Provider Business Practice Location Address
First Line	:	5470 CHENE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-2746
Country	:	US
Telephone Number	:	313-976-5320
Fax Number	:	313-579-0610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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