Provider Demographics
NPI:1750448809
Name:BARNS, SUSAN GRACE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GRACE
Last Name:BARNS
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 1:5600 W MAPLE RD
Mailing Address - Street 2:SUITE B201
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3704
Mailing Address - Country:US
Mailing Address - Phone:248-860-1211
Mailing Address - Fax:248-860-1211
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:SUITE B201
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-860-1211
Practice Address - Fax:248-860-1211
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680107000611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP24070Medicare ID - Type Unspecified