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NPI Code Detail

MEDICARE: LATRESA RICE LMSW

MEDICARE: LATRESA RICE 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
11041C0700XClinical Social Worker6801091344MI

General Provider Information

NPI Number : 1578971206
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATRESA RICE LMSW
Provider Business Mailing Address
First Line : 3200 GREENFIELD RD STE 300
Second Line :
City : DEARBORN
State : MI
Zip : 48120-1805
Country : US
Telephone Number : 646-453-6777
Fax Number : 833-900-1747
Provider Business Practice Location Address
First Line : 3200 GREENFIELD RD STE 300
Second Line :
City : DEARBORN
State : MI
Zip : 48120-1805
Country : US
Telephone Number : 646-453-6777
Fax Number : 833-900-1747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2014
Last Update Date : 12/11/2023

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