MEDICARE: MRS. SUZANNE RENSEL THOMAS LMSW

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	6801011281	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005013741	OTHER	MI	AETNA PROVIDER NUMBER
2	80-0890917	OTHER	MI	BLUE CROSS BLUE SHILE ID

General Provider Information

NPI Number	:	1053477141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE RENSEL THOMAS LMSW

Provider Business Mailing Address
First Line	:	2254 BORDEAUX ST
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-3017
Country	:	US
Telephone Number	:	248-767-5040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2254 BORDEAUX ST
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-3017
Country	:	US
Telephone Number	:	248-767-5040
Fax Number	:

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

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	02/27/2026

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