Provider Demographics
NPI:1083924054
Name:KAREN WEBB ACSW PC
Entity type:Organization
Organization Name:KAREN WEBB ACSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:313-642-1997
Mailing Address - Street 1:18090 MACK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6251
Mailing Address - Country:US
Mailing Address - Phone:313-642-1997
Mailing Address - Fax:313-642-1998
Practice Address - Street 1:18090 MACK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6251
Practice Address - Country:US
Practice Address - Phone:313-642-1997
Practice Address - Fax:313-642-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801046577251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008915260OtherBLUE CROSS/BLUE SHIELD OF MICHIGAN
MI0891526Medicare PIN