MEDICARE: DIANE MARIE DORE MSW

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	6801094471	MI
2	104100000X	Social Worker	6801094471	MI

General Provider Information

NPI Number	:	1447502638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MARIE DORE MSW

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	6255 NEFF RD
Second Line	:
City	:	MOUNT MORRIS
State	:	MI
Zip	:	48458-2761
Country	:	US
Telephone Number	:	810-591-9333
Fax Number	:

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

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	12/11/2018

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