Provider Demographics
NPI:1407849821
Name:PLEISS, MARTHA A (LMSW LMST)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:PLEISS
Suffix:
Gender:F
Credentials:LMSW LMST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1216
Mailing Address - Country:US
Mailing Address - Phone:248-544-7168
Mailing Address - Fax:248-544-7168
Practice Address - Street 1:1020 N LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1216
Practice Address - Country:US
Practice Address - Phone:248-544-7168
Practice Address - Fax:248-544-7168
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010146021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383149163OtherTAX ID NUMBER
MI0N62990Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MI383149163OtherTAX ID NUMBER