Doctor Name: | DEEPA NANDAMUDI |
NPI Number: | 1316361967 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6801068852 |
Business Practice Address: | 3050 Commerce Dr Fort Gratiot, MI - 480593819 |
Business Phone Number: | 8103854441 |
Business Fax Number: | 8103851540 |
Mailing Address: | 3050 Commerce Dr, FORT GRATIOT |
State: | MI |
Postal Code: | 480593819 |
Phone Number: | 8103854441 |
Fax Number: | 8103851540 |
NPI Enumeration Date: | 02/18/2014 |
NPI Last Update Date: | 03/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801068852 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |