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5600 W Maple Rd Ste B212 West Bloomfield MI 48322-3787 | |
| (248) 605-5049 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 5600 W Maple Rd Ste B212, West Bloomfield, Michigan |
| Authorized Official Name and Position | Laurel Jean Rebenstock, Lmsw, Caadc (CLINICAL DIRECTOR/OWNER) |
| Authorized Official Contact | 2486055049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5600 W Maple Rd Ste B212 West Bloomfield MI 48322-3787 Ph: (248) 605-5049 | 5600 W Maple Rd Ste B212 West Bloomfield MI 48322-3787 Ph: (248) 605-5049 |
| NPI Number | 1851049340 |
|---|---|
| Provider Enumeration Date | 03/14/2022 |
| Last Update Date | 01/21/2024 |
| Certification Date | 01/21/2024 |
| Medicare PECOS PAC ID | 3375986722 |
|---|---|
| Medicare Enrollment ID | O20240213001914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851049340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Laurel J Rebenstock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033370747 PECOS PAC ID: 1456428499 Enrollment ID: I20080917000532 |
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