Provider Demographics
NPI:1154801322
Name:NEW LEAF THERAPY
Entity type:Organization
Organization Name:NEW LEAF THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-652-1510
Mailing Address - Street 1:1938 BURDETTE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1982
Mailing Address - Country:US
Mailing Address - Phone:313-652-1510
Mailing Address - Fax:248-876-9454
Practice Address - Street 1:1938 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1982
Practice Address - Country:US
Practice Address - Phone:313-652-1510
Practice Address - Fax:248-876-9454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010976411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty