Provider Demographics
NPI:1588737746
Name:GAYDOS, NANCY J (ACSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:GAYDOS
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44038 WOODWARD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5035
Mailing Address - Country:US
Mailing Address - Phone:248-858-7474
Mailing Address - Fax:248-858-7224
Practice Address - Street 1:44038 WOODWARD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5035
Practice Address - Country:US
Practice Address - Phone:248-858-7474
Practice Address - Fax:248-858-7224
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010008101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M86710Medicare ID - Type Unspecified