Provider Demographics
NPI:1154729689
Name:FOREMAN, MICHAEL (LBSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23163 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3922
Mailing Address - Country:US
Mailing Address - Phone:248-476-2305
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PLACE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4274
Practice Address - Country:US
Practice Address - Phone:313-871-2337
Practice Address - Fax:313-871-1805
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI802018803104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker