MEDICARE: NICOLE VALENTINE 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	104100000X	Social Worker	6801094492	MI
2	1041C0700X	Clinical Social Worker	6801094492	MI

General Provider Information

NPI Number	:	1457896110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE VALENTINE LMSW

Provider Business Mailing Address
First Line	:	500 KIRTS BLVD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-4134
Country	:	US
Telephone Number	:	248-824-6378
Fax Number	:

Provider Business Practice Location Address
First Line	:	8223 KINMORE ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-1231
Country	:	US
Telephone Number	:	313-506-7231
Fax Number	:

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

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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