MEDICARE: ENLIGHTEN SOCIAL SERVICES, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760056154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIGHTEN SOCIAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	3145 CHESTNUT ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-4313
Country	:	US
Telephone Number	:	313-236-2740
Fax Number	:

Provider Business Practice Location Address
First Line	:	3145 CHESTNUT ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-4313
Country	:	US
Telephone Number	:	313-236-2740
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	BERNADETTE RICHARDSON
Credential	:	LMSW
Telephone Number	:	313-236-2740

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	05/19/2021

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