Provider Demographics
NPI:1578640637
Name:NEMENZIK, JEAN (LMSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:NEMENZIK
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 1:440 BURROUGHS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3429
Mailing Address - Country:US
Mailing Address - Phone:313-348-5790
Mailing Address - Fax:
Practice Address - Street 1:440 BURROUGHS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3429
Practice Address - Country:US
Practice Address - Phone:313-348-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M29340Medicare ID - Type Unspecified