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NPI Code Detail

MEDICARE: MS. KATHERINE BAETZ LMSW-C, CAADC, ADS

MEDICARE: MS. KATHERINE BAETZ LMSW-C, CAADC, ADS
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
1101Y00000XCounselor6801100920MI
21041C0700XClinical Social Worker6801106055MI

General Provider Information

NPI Number : 1871014332
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHERINE BAETZ LMSW-C, CAADC, ADS
Provider Business Mailing Address
First Line : 1504 ALINE DR
Second Line :
City : GROSSE POINTE WOODS
State : MI
Zip : 48236-1002
Country : US
Telephone Number : 313-530-7414
Fax Number :
Provider Business Practice Location Address
First Line : 23100 JEFFERSON AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48080-2756
Country : US
Telephone Number : 586-335-2006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2017
Last Update Date : 08/30/2023

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