MEDICARE: MRS. LAVERNE MARIE MOREN LMSW,ACSW

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	6801058938	MI

General Provider Information

NPI Number	:	1043358310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAVERNE MARIE MOREN LMSW,ACSW

Provider Business Mailing Address
First Line	:	155 ROCHDALE DR S
Second Line	:	SUITE B
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2276
Country	:	US
Telephone Number	:	248-842-4163
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 ROCHDALE DR S
Second Line	:	SUITE B
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2276
Country	:	US
Telephone Number	:	248-842-4163
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	06/11/2009

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