1497767768 NPI number — MS. CECELIA MAXWELL SPENCER MSW

Table of content: MS. CECELIA MAXWELL SPENCER MSW (NPI 1497767768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497767768 NPI number — MS. CECELIA MAXWELL SPENCER MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
CECELIA
Provider Middle Name:
MAXWELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1497767768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4646 JOHN R ST
Provider Second Line Business Mailing Address:
SW118
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-576-1000
Provider Business Mailing Address Fax Number:
313-576-1041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4646 JOHN R ST
Provider Second Line Business Practice Location Address:
SW118
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-576-1000
Provider Business Practice Location Address Fax Number:
313-576-1041
Provider Enumeration Date:
08/13/2006

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:  6801086982 , 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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