1952451536 NPI number — CANDICE HEMBERG LMSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952451536 NPI number — CANDICE HEMBERG LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEMBERG
Provider First Name:
CANDICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEMBERG
Provider Other First Name:
CANDICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952451536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36975 UTICA ROAD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-226-3440
Provider Business Mailing Address Fax Number:
586-226-3672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45445 MOUND
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
SHELBY TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-254-5660
Provider Business Practice Location Address Fax Number:
586-254-0622
Provider Enumeration Date:
01/12/2007

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:  6801020783 , 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)

  • Identifier: L968699 . This is a "DEPT OF COMMUNITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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