Provider Demographics
NPI:1508165135
Name:MEHTA, RAJEN VINOD (MSW)
Entity Type:Individual
Prefix:MR
First Name:RAJEN
Middle Name:VINOD
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 ROUNDTREE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2337
Mailing Address - Country:US
Mailing Address - Phone:586-219-7010
Mailing Address - Fax:
Practice Address - Street 1:2973 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2337
Practice Address - Country:US
Practice Address - Phone:586-219-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010926991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical