1528292075 NPI number — MS. DELORES ELAINE GILLERY LMSW, ACSW

Table of content: MS. DELORES ELAINE GILLERY LMSW, ACSW (NPI 1528292075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528292075 NPI number — MS. DELORES ELAINE GILLERY LMSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLERY
Provider First Name:
DELORES
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528292075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18227 OAKFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48235-3282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-478-1569
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35300 NANKIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
WESTLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48185-7222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-261-1842
Provider Business Practice Location Address Fax Number:
734-261-5287
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801088109 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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