Provider Demographics
NPI:1346355005
Name:DESOFF, JUDITH (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:DESOFF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:37399 GARFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3672
Mailing Address - Country:US
Mailing Address - Phone:586-421-5164
Mailing Address - Fax:586-421-5179
Practice Address - Street 1:37399 GARFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3672
Practice Address - Country:US
Practice Address - Phone:586-421-5164
Practice Address - Fax:586-421-5179
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010129871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOQ26426269Medicare ID - Type Unspecified