Provider Demographics
NPI:1558371039
Name:HUBERT, DENISE M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:M
Last Name:HUBERT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:HUBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:16950 19 MILE RD
Mailing Address - Street 2:SUITE 3 F
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4804
Mailing Address - Country:US
Mailing Address - Phone:586-855-5022
Mailing Address - Fax:586-855-5026
Practice Address - Street 1:16950 19 MILE RD
Practice Address - Street 2:SUITE 3 F
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4804
Practice Address - Country:US
Practice Address - Phone:586-855-5022
Practice Address - Fax:586-855-5026
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010742461041C0700X
CALCS171571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM97240054Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER