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NPI Code Detail

MEDICARE: CAROL DIANE PSAILA

MEDICARE: CAROL DIANE PSAILA
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
11041C0700XClinical Social Worker6801077434MI

General Provider Information

NPI Number : 1144769050
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROL DIANE PSAILA
Provider Business Mailing Address
First Line : 7618 BAY TREE DR
Second Line :
City : YPSILANTI
State : MI
Zip : 48197-9572
Country : US
Telephone Number : 734-358-3810
Fax Number :
Provider Business Practice Location Address
First Line : 3830 PACKARD ST STE 250
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-2273
Country : US
Telephone Number : 734-358-3810
Fax Number :
Authorized Official
Title or Position : LMSW
Name : CAROL D PSAILA
Credential : LMSW
Telephone Number : 734-358-3810
Provider Enumeration Date : 02/13/2017
Last Update Date : 02/13/2017

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