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NPI Code Detail

MEDICARE: HOLLY BELASCO LLMSW

MEDICARE: HOLLY BELASCO LLMSW
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
1390200000XStudent in an Organized Health Care Education/Training Program
2104100000XSocial Worker6801103194MI

General Provider Information

NPI Number : 1588051700
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY BELASCO LLMSW
Provider Business Mailing Address
First Line : 2700 HAMLIN BLVD
Second Line :
City : INKSTER
State : MI
Zip : 48141-2206
Country : US
Telephone Number : 734-941-4991
Fax Number : 313-565-0309
Provider Business Practice Location Address
First Line : 2700 HAMLIN BLVD
Second Line :
City : INKSTER
State : MI
Zip : 48141-2206
Country : US
Telephone Number : 734-941-4991
Fax Number : 313-565-0309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2015
Last Update Date : 12/11/2018

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