MEDICARE: LIANEE TAIT 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	6801081621	MI

General Provider Information

NPI Number	:	1518341155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANEE TAIT LMSW

Provider Business Mailing Address
First Line	:	20816 E 11 MILE RD STE 115
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1579
Country	:	US
Telephone Number	:	313-600-7167
Fax Number	:

Provider Business Practice Location Address
First Line	:	20816 E 11 MILE RD STE 115
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1579
Country	:	US
Telephone Number	:	313-600-7167
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	07/21/2015

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