MEDICARE: EMILY MANDIGO LMSW, CCS, CAADC

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	6801085696	MI

General Provider Information

NPI Number	:	1306255906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MANDIGO LMSW, CCS, CAADC

Provider Business Mailing Address
First Line	:	2045 E WEST MAPLE RD STE D-407
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-3801
Country	:	US
Telephone Number	:	248-858-7766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 W 12 MILE RD
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-1826
Country	:	US
Telephone Number	:	248-853-0750
Fax Number	:

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	11/18/2019

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