Provider Demographics
NPI:1952358491
Name:GREENBLATT, SUSAN T AIDEM (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:T AIDEM
Last Name:GREENBLATT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 W MAPLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4405
Mailing Address - Country:US
Mailing Address - Phone:248-489-1550
Mailing Address - Fax:248-489-9767
Practice Address - Street 1:6024 W MAPLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4405
Practice Address - Country:US
Practice Address - Phone:248-489-1550
Practice Address - Fax:248-489-9767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010665601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical