MEDICARE: GLORIA ILENE DUROCHER L.M.S.W.

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	6801064128	MI

General Provider Information

NPI Number	:	1306952288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA ILENE DUROCHER L.M.S.W.

Provider Business Mailing Address
First Line	:	131 KERCHEVAL AVE
Second Line	:	390
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3629
Country	:	US
Telephone Number	:	313-885-6400
Fax Number	:	313-885-6807

Provider Business Practice Location Address
First Line	:	131 KERCHEVAL AVE
Second Line	:	390
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3629
Country	:	US
Telephone Number	:	313-885-6400
Fax Number	:	313-885-6807

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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