MEDICARE: MS. ANNETTE LOUISE FORTINO LCSW ACSW CAC-II

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	104100000X	Social Worker	6801035655	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6224761	OTHER	MI	UBH

General Provider Information

NPI Number	:	1194838599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNETTE LOUISE FORTINO LCSW ACSW CAC-II

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854
Country	:	US
Telephone Number	:	517-676-9788
Fax Number	:	517-676-3438

Provider Business Practice Location Address
First Line	:	1535 INDUSTRIAL PARK DR
Second Line	:
City	:	HART
State	:	MI
Zip	:	49420-8377
Country	:	US
Telephone Number	:	517-231-6550
Fax Number	:

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/13/2025

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