Provider Demographics
NPI:1245244805
Name:REDMOND, MARJORIE H (LMSW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:H
Last Name:REDMOND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30375 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE #200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3297
Mailing Address - Country:US
Mailing Address - Phone:248-354-5760
Mailing Address - Fax:248-254-3333
Practice Address - Street 1:30375 NORTHWESTERN HWY, SUITE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-254-3332
Practice Address - Fax:248-254-3333
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR0331341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMR033134OtherLICENSE
MIMI4652Medicare PIN