MEDICARE: ANDREA NITZKIN 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
1	1041C0700X	Clinical Social Worker	6801088377	MI

General Provider Information

NPI Number	:	1366623373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA NITZKIN LMSW

Provider Business Mailing Address
First Line	:	6555 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4926
Country	:	US
Telephone Number	:	248-592-2300
Fax Number	:	248-592-2340

Provider Business Practice Location Address
First Line	:	28592 ORCHARD LAKE RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2961
Country	:	US
Telephone Number	:	248-592-7072
Fax Number	:

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	02/19/2020

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