Provider Demographics
NPI:1275353435
Name:GORENFLO, JODY (LMSW)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:GORENFLO
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 1:1241 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1279
Mailing Address - Country:US
Mailing Address - Phone:248-982-2433
Mailing Address - Fax:
Practice Address - Street 1:5505 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2614
Practice Address - Country:US
Practice Address - Phone:248-764-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical