MEDICARE: MICHIGAN WOMEN'S PSYCHOLOGY SERVICES

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

General Provider Information

NPI Number	:	1972187714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN WOMEN'S PSYCHOLOGY SERVICES

Provider Business Mailing Address
First Line	:	3035 12TH ST
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-5605
Country	:	US
Telephone Number	:	734-558-0782
Fax Number	:

Provider Business Practice Location Address
First Line	:	18518 OUTER DR
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1874
Country	:	US
Telephone Number	:	734-494-2092
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MASTER OF SOCIAL WORK
Name	:	MARGARET MARIANNA SHEEHAN
Credential	:	LMSW
Telephone Number	:	734-494-2092

Provider Enumeration Date	:	05/07/2021
Last Update Date	:	05/07/2021

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