| Pllc | |
|
37799 Professional Center Dr Ste 106 Livonia MI 48754 | |
| (248) 343-4695 | |
| Not Available |
| Full Name | Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 37799 Professional Center Dr Ste 106, Livonia, Michigan |
| Authorized Official Name and Position | Nancy Dahms Petrides (CLINICIAN OWNER) |
| Authorized Official Contact | 2483434695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pllc 37799 Professional Center Dr Ste 106 Livonia MI 48754 Ph: (248) 343-4695 | Pllc 37799 Professional Center Dr Ste 106 Livonia MI 48754 Ph: (248) 343-4695 |
| NPI Number | 1861571846 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1951377688 |
|---|---|
| Medicare Enrollment ID | O20040903000644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861571846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 6801033601 (Michigan) | Primary |
| Provider Name | Nancy D Petrides |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902869233 PECOS PAC ID: 7810963543 Enrollment ID: I20040903000930 |
| Provider Name | Dawn M Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275882797 PECOS PAC ID: 2860776069 Enrollment ID: I20170308000407 |
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