MEDICARE: JANE MENDELSOHN MSW LMSW LLC

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

General Provider Information

NPI Number	:	1053926931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE MENDELSOHN MSW LMSW LLC

Provider Business Mailing Address
First Line	:	32400 OLDE FRANKLIN DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1740
Country	:	US
Telephone Number	:	248-909-3567
Fax Number	:	248-658-8777

Provider Business Practice Location Address
First Line	:	32400 OLDE FRANKLIN DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1740
Country	:	US
Telephone Number	:	248-909-3567
Fax Number	:	248-658-8777

Authorized Official
Title or Position	:	OWNER
Name	:	JANE MENDELSOHN
Credential	:	MSW LMSW
Telephone Number	:	248-909-3567

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/09/2020

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