Provider Demographics
NPI:1073866497
Name:GENHEIMER, ERIC N (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:N
Last Name:GENHEIMER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 S ROCHESTER RD
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5160
Mailing Address - Country:US
Mailing Address - Phone:248-844-6234
Mailing Address - Fax:248-844-6237
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:SUITE 1400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5160
Practice Address - Country:US
Practice Address - Phone:248-844-6234
Practice Address - Fax:248-844-6237
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010800941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801080094OtherSTATE OF MICHIGAN DEPT OF LICENSING AND REGULATORY AFFAIRS BOARD OF SOCIAL WORK