MEDICARE: NICOLE MARIE SOBH 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
1	104100000X	Social Worker	6801090425	MI

General Provider Information

NPI Number	:	1912102740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE SOBH LMSW

Provider Business Mailing Address
First Line	:	330 S LAFAYETTE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1316
Country	:	US
Telephone Number	:	313-969-3705
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 S LAFAYETTE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1316
Country	:	US
Telephone Number	:	313-969-3705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	04/19/2025

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