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NPI Code Detail

MEDICARE: THREE FATES LLC

MEDICARE: THREE FATES LLC
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 Worker

General Provider Information

NPI Number : 1821782400
Entity Type Code : Organization
Provider Name (Legal Business Name) : THREE FATES LLC
Provider Business Mailing Address
First Line : 3611 HENRY ST
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4705
Country : US
Telephone Number : 231-900-3096
Fax Number :
Provider Business Practice Location Address
First Line : 3611 HENRY ST
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4705
Country : US
Telephone Number : 231-900-3096
Fax Number :
Authorized Official
Title or Position : OWNER, LCSW
Name : REBECCA NEWMAN
Credential :
Telephone Number : 231-725-5857
Provider Enumeration Date : 06/06/2023
Last Update Date : 03/15/2026

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Directions to “THREE FATES LLC ” Practice Location

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