Provider Demographics
NPI:1841444866
Name:CHANEY, GWENDOLYN ELAINE (MSW)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ELAINE
Last Name:CHANEY
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 1:1969 W BOSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1728
Mailing Address - Country:US
Mailing Address - Phone:313-865-4562
Mailing Address - Fax:
Practice Address - Street 1:1969 W BOSTON BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1728
Practice Address - Country:US
Practice Address - Phone:313-865-4562
Practice Address - Fax:313-865-9252
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010716231041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical