Provider Demographics
NPI:1578150884
Name:DIMPERIO, EMILY ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:DIMPERIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:DIMPERIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:39465 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1600
Mailing Address - Country:US
Mailing Address - Phone:877-906-9699
Mailing Address - Fax:
Practice Address - Street 1:822 CHERRY ST SE APT 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1488
Practice Address - Country:US
Practice Address - Phone:585-857-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011082611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical