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NPI Code Detail

MEDICARE: MS. MERRILYN MAE THOMAS LMSW

MEDICARE: MS. MERRILYN MAE 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
11041C0700XClinical Social Worker6801034849MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MT034849OTHERMIBCBS PIN

General Provider Information

NPI Number : 1215081922
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MERRILYN MAE THOMAS LMSW
Provider Business Mailing Address
First Line : 18610 SAN QUENTIN DR
Second Line :
City : LATHRUP VILLAGE
State : MI
Zip : 48076-7808
Country : US
Telephone Number : 313-531-2500
Fax Number : 313-255-3471
Provider Business Practice Location Address
First Line : 24424 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-3653
Country : US
Telephone Number : 313-531-2500
Fax Number : 313-255-3471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/09/2007

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