MEDICARE: EMILY BURCHAM LLMSW

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	6851107950	MI

General Provider Information

NPI Number	:	1184350522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY BURCHAM LLMSW

Provider Business Mailing Address
First Line	:	504 E WOODWARD HEIGHTS BLVD
Second Line	:
City	:	HAZEL PARK
State	:	MI
Zip	:	48030-1447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 LIVERNOIS ST STE 102
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2676
Country	:	US
Telephone Number	:	616-209-9295
Fax Number	:

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

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	05/14/2026

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