MEDICARE: MRS. ERAINA ANN POOLE 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	680134799	MI

General Provider Information

NPI Number	:	1487822037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERAINA ANN POOLE MSW

Provider Business Mailing Address
First Line	:	225 E 5TH ST
Second Line	:	SUITE 105
City	:	FLINT
State	:	MI
Zip	:	48502-1641
Country	:	US
Telephone Number	:	810-767-0522
Fax Number	:	810-767-0699

Provider Business Practice Location Address
First Line	:	225 E 5TH ST
Second Line	:	SUITE 105
City	:	FLINT
State	:	MI
Zip	:	48502-1641
Country	:	US
Telephone Number	:	810-767-0522
Fax Number	:	810-767-0699

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

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	01/08/2021

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