Provider Demographics
NPI:1407104102
Name:ML SOCIAL WORK GROUP
Entity Type:Organization
Organization Name:ML SOCIAL WORK GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:248-962-3510
Mailing Address - Street 1:3290 CAMINITO EASTBLUFF
Mailing Address - Street 2:STE 125
Mailing Address - City:LAJOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2878
Mailing Address - Country:US
Mailing Address - Phone:858-255-1595
Mailing Address - Fax:
Practice Address - Street 1:3290 CAMINITO EASTBLUFF
Practice Address - Street 2:STE 125
Practice Address - City:LAJOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-2878
Practice Address - Country:US
Practice Address - Phone:858-255-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68010841221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty