| Lisa Kent Llc | |
|
2485 Doleman Dr West Bloomfield MI 48324-1405 | |
| (248) 709-5510 | |
| Not Available |
| Full Name | Lisa Kent Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2485 Doleman Dr, West Bloomfield, Michigan |
| Authorized Official Name and Position | Lisa Kent (OWNER) |
| Authorized Official Contact | 2487095510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Kent Llc 2485 Doleman Dr West Bloomfield MI 48324-1405 Ph: (248) 709-5510 | Lisa Kent Llc 2485 Doleman Dr West Bloomfield MI 48324-1405 Ph: (248) 709-5510 |
| NPI Number | 1558136523 |
|---|---|
| Provider Enumeration Date | 11/20/2023 |
| Last Update Date | 05/26/2024 |
| Certification Date | 05/26/2024 |
| Medicare PECOS PAC ID | 3173967643 |
|---|---|
| Medicare Enrollment ID | O20240223000892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558136523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa Victoria Kent |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245810209 PECOS PAC ID: 9436593902 Enrollment ID: I20240223001106 |
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