Provider Demographics
NPI:1568631976
Name:MILETIC, MICHELLE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:MILETIC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3855
Mailing Address - Country:US
Mailing Address - Phone:248-417-9521
Mailing Address - Fax:248-593-8542
Practice Address - Street 1:620 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3855
Practice Address - Country:US
Practice Address - Phone:248-417-9521
Practice Address - Fax:248-593-8542
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI6801075003102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical