Provider Demographics
NPI:1871523621
Name:URBAN, GERALD EDWIN (MSW)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:EDWIN
Last Name:URBAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 FIELDBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3206
Mailing Address - Country:US
Mailing Address - Phone:248-932-5886
Mailing Address - Fax:248-932-5886
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 550
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-213-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010133401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical