Provider Demographics
NPI:1497747174
Name:MENDELSOHN, JANE H (ACSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:H
Last Name:MENDELSOHN
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28800 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2981
Mailing Address - Country:US
Mailing Address - Phone:248-932-2500
Mailing Address - Fax:248-932-2506
Practice Address - Street 1:28800 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2981
Practice Address - Country:US
Practice Address - Phone:248-932-2500
Practice Address - Fax:248-932-2506
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010351571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS97304Medicare UPIN
MI0F34953024Medicare PIN
MI0M93470Medicare ID - Type Unspecified