Provider Demographics
NPI:1508059718
Name:BISHOP, MARIEDA A (MSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIEDA
Middle Name:A
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 EATON RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2063
Mailing Address - Country:US
Mailing Address - Phone:248-398-2074
Mailing Address - Fax:
Practice Address - Street 1:1110 CATALPA DR
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1125
Practice Address - Country:US
Practice Address - Phone:248-398-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICSW68010673901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M29480Medicare PIN