Provider Demographics
NPI:1811550437
Name:NEUBURGER, KATHARINE ELISE HAZARD (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ELISE HAZARD
Last Name:NEUBURGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:VALLERAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1723 RUSTIC RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1250
Mailing Address - Country:US
Mailing Address - Phone:248-390-9768
Mailing Address - Fax:
Practice Address - Street 1:23965 NOVI RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3232
Practice Address - Country:US
Practice Address - Phone:248-344-7420
Practice Address - Fax:248-344-7423
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103868104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker